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Impact and natural history of postprocedural aortic regurgitation on early and midterm mortality following transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis

Ielasi, Alfonso; Latib, Azeem; Sacco, Francesco Maria; Costopoulos, Charis; Figini, Filippo; Grimaldi, Antonio; Naim, Charbel; Maisano, Francesco; Chieffo, Alaide; Montorfano, Matteo; Alfieri, Ottavio; Colombo, Antonio

Journal of Cardiovascular Medicine: April 2015 - Volume 16 - Issue 4 - p 286–295
doi: 10.2459/JCM.0000000000000249
Original articles

Background Post-procedural aortic regurgitation (AR) negatively impacts the prognosis after trans-catheter aortic valve implantation. However, data evaluating the impact of different post-procedural AR grades (particularly mild) on clinical outcomes are still important.

Aim and Methods A retrospective cohort analysis was performed on all consecutive patients with severe aortic stenosis who underwent trans-catheter aortic valve implantation between July 2008 and August 2011 in a single Institution. Aim of the study was to evaluate the impact of different post-procedural AR grades on early and mid-term clinical outcomes.

Results 322 consecutive patients were evaluated. At post-procedural echocardiographic evaluation: 105 (32.6%) patients had no AR, 204 (63.4%) mild AR and 13 (4%) moderate/severe AR. In-hospital mortality was higher in patients with moderate/severe AR than in those with absent or mild AR (38.5% vs. 2.6%, P < 0.001). At a median clinical follow-up of 342 days [interquartile range 93–485] cardiovascular mortality was 2.9% in patients without AR; 13.2% in the mild AR group (P = 0.004 vs. absent AR) and 46.2% in the moderate/severe AR group (P < 0.001 vs. mild or absent AR). On multivariable analysis, post-procedural AR (hazard ratio = 2.65 absent vs. present any grade, 95% confidence interval = 1.11–6.29; P = 0.027) was an independent predictor of mid-term mortality.

Conclusions The impact of post-procedural AR on outcomes after trans-catheter aortic valve implantation is proportional with its grade even in case of mild post-procedural AR compared to absent. This study confirms that every effort should be made to reduce the grade of post-procedural AR after trans-catheter aortic valve implantation with current devices.

aInterventional Cardiology Unit, San Raffaele Scientific Institute

bInterventional Cardiology Unit, EMO-GVM Centro Cuore Columbus

cDivision of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy

*Dr Alfonso Ielasi and Dr Azeem Latib contributed equally to the article and are joint first authors.

Correspondence to Azeem Latib, MD, EMO-GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy Tel: +39 024 819 2920; fax: +39 024 819 3433; e-mail: alatib@gmail.com

Received 7 July, 2014

Revised 4 November, 2014

Accepted 10 November, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.