Original title: Post-procedural aortic regurgitation in balloon-expandable and self-expandable TAVR procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE 2 registry. Reference: Van Belle E et al. Circulation. 2014; Epub ahead of print.

This study used transthoracic echocardiography (TTE) to evaluate 2769 patients undergoing successful TAVI in 34 centers in France, enrolled in the FRANCE 2 Registry. 1872 of these patients (67.6%) received the expandable balloon valve Edwards Sapien o Sapien XT and the rest the self expandable CoreValve.

At 306 median follow up, mild/severe (grade ≥ 2) was observed in 15.8% of the population and was more frequent in those that received the CoreValve (21.5% vs 13%; p= 0.0001).

Mild/severe post procedural AR was a strong predictor of one year mortality both for the Edwards valve (OR 2.50; p= 0.0001) and the CoreValve (OR 2.11; p= 0.0001).

This grade of aortic regurgitation was not well tolerated by those patients with renal failure, AR

No association was observed between the different devices and some of the AR predictors, only between aortic annulus size and prosthesis diameter. During follow up, a 11.3% global mortality rate was observed (6.3% was heart death), with a significant raise of both in those with mild/severe AR.

Conclusion

Mild to severe AR was observed in 15.8% of patients that received successful TAVI and resulted the strongest independent predictor of one year mortality.

Editorial Comment

Minimizing the impact of AR in those with previous AR suggests that the ventricle has already adapted to volume overload, which is an advantage in treating this complication. 

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