Original title: Impact of Post-Procedural Aortic Regurgitation on Mortality Alter Trancatheter Aortic Valve Implantation Reference: Kentaro Hayashida, et al. J Am Coll Interv 2012;5:1247-56

Transcatheter aortic valve implantation (TAVI) sprung up as a valid strategy to treat patients with severe high risk AS (aortic stenosis). However, residual aortic regurgitation (post AR) and post-dilation remain unsolved. 

Between October 2006 and October 2011, 400 consecutive patients were analyzed. According to post AR grade, patients were divided into 3 groups: grade 0 or group 1 (G1) 99 patients, grade 2 or group 2 (G2) 89 patients and grade 3 – 4 group 3 (G3) 12 patients.

The implanted valve was Edwards (Edwards Lifesciences, Irvine, California) in 86.8% of patients and CoreValve (Medtronic, Minneapolis, Minnesota) in the remaining 13.2%. There were no differences in valve diameter between the groups. Post dilation and mitral regurgitation were significantly more frequent in G3. Interestingly, the degree of post procedure mitral regurgitation increased in line with the degree of aortic insufficiency. 

At 30 days, mortality was 9.5%, with no differences in mortality, kidney failure, or major vascular complications between groups. At 297 days follow up (101-607), 109 patients had died (64 G1, 36 G2 and 9 G3). G3 had significantly worse outcome. Mortality at 24 months was 28%, 40.4% and 75% respectively. G3 had considerably worse evolution. Post AR was an independent predictor of mid-term mortality.

Conclusion 

The presence of post AR >2 is associated with worse mid-term evolution, therefore valve selection is very important, and post dilation, when required, may contribute to solve this problem.

Editorial Comment:

This study is important because with a small number of patients, it has shown that post AR grade 2 is associated with poor mid-term outcome, which indicates a careful selection of valve implant when planning the most effective strategy. Anatomical predictors of post AR would be of great use, as tools to better strategy planning and to facilitate de development of better valve devices. 

Courtesy of Dr. Carlos Fava
Interventional Cardiologist.
Favaloro Foundation. Argentina.

Dr. Carlos Fava para SOLACI.ORG