ISSN 2996-8215
International Journal of Cardiology | Vol. 5, No. 8, August 2014 | pp. 57–64
DOI: 10.46882/2014/IJC/000065
Original Research Article
Prognostic Impact of Moderate Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation
Jean-Pierre Dubois¹, Pierre Vigneron¹, Lucia Rossi²
¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
²Department of Cardiac Surgery, University of Milan, Milan, Italy
Abstract:
Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery for high-risk patients with severe aortic stenosis. However, paravalvular regurgitation (PVR) remains a common post-procedural finding due to calcific asymmetry. This study investigated the 3-year prognostic impact of post-procedural moderate PVR on mortality and heart failure hospitalization. We prospectively followed 240 consecutive high-risk patients who underwent successful TAVI with early-generation balloon-expandable or self-expanding valves. Post-procedural PVR severity was graded using multi-parametric transthoracic echocardiography at discharge. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization at 36 months. Moderate PVR was identified in 38 patients (15.8%), while 202 patients had none, trace, or mild PVR. At 3 years, the primary composite endpoint occurred significantly more frequently in the moderate PVR cohort than in the trace-to-mild group (47.4% vs. 21.8%, log-rank p < 0.001). This difference was driven by both higher all-cause mortality (28.9% vs. 12.4%, p = 0.01) and recurrent heart failure hospitalizations (36.8% vs. 14.9%, p < 0.01). Multivariable Cox proportional hazards analysis confirmed that post-procedural moderate PVR was an independent predictor of the 3-year composite endpoint (hazard ratio: 2.34, 95% CI: 1.41–3.88, p = 0.001). Post-procedural moderate paravalvular regurgitation significantly compromises 3-year survival and survival freedom from heart failure hospitalizations after TAVI, underscoring the importance of deploying next-generation anti-leak valve designs.
Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Paravalvular regurgitation, Echocardiography, Mortality, Long-term outcomes
Received: May 12, 2014; Revised: June 25, 2014; Accepted: July 14, 2014; Published: August 20, 2014
Citation: International Journal of Cardiology, 2014, Vol. 5, No. 8, pp. 57–64, DOI: 10.46882/2014/IJC/000065