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Structural Heart
The Journal of the Heart Team
Volume 5, 2021 - Issue 2
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Original Research

Outcomes of Mild Aortic Regurgitation After Transcatheter Aortic Valve Replacement

Johnny Chahinea Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USAORCID Iconhttps://orcid.org/0000-0001-9592-4262View further author information
, MDORCID Icon,
Amer N. Kadria Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Rama Dilip Gajulapallia Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Hassan Laka Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USAORCID Iconhttps://orcid.org/0000-0002-4778-5461View further author information
, MDORCID Icon,
Amar Krishnaswamyb Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Grant Reedb Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Oscar Pereza Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Rishi Purib Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD, PhD,
Zoran Popovicc Department of Cardiovascular Medicine, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD, PhD,
Beni Rai Vermaa Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USAORCID Iconhttps://orcid.org/0000-0003-0970-2028View further author information
, MDORCID Icon,
Manpreet Kaurb Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Mohamed M. Gada Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Raunak M. Naira Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Wael Jaberc Department of Cardiovascular Medicine, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
James Yund Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Paul Schoenhagenc Department of Cardiovascular Medicine, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
Serge C. Harbc Department of Cardiovascular Medicine, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD,
E. Murat Tuzcub Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAORCID Iconhttps://orcid.org/0000-0002-8932-9157View further author information
, MDORCID Icon,
Lars G. Svenssond Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USAView further author information
, MD, PhD &
Samir R. Kapadiab Department of Cardiovascular Medicine, Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USACorrespondence[email protected]
View further author information
, MD show all
Pages 201-207 | Received 25 Aug 2020, Accepted 14 Dec 2020, Published online: 25 Feb 2021
 
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ABSTRACT

Background: There has been an explosion in the clinical application of transcatheter aortic valve replacement (TAVR) worldwide. While moderate and severe grades of paravalvular regurgitation (PVR) are established as poor prognostic indicators, the impact of mild PVR is unclear. We therefore aimed to compare outcomes after TAVR between those who develop mild PVR versus none or trivial PVR.

Methods: We identified 1,098 consecutive patients who underwent TAVR from January 2014 to December 2017. The primary outcome was all-cause mortality using Kaplan Meier curves. The secondary outcomes included heart failure readmissions and the composite endpoints of early safety and clinical efficacy according to VARC-2 definitions.

Results: The median age was 82 years, 43% were females, and 94% were Caucasian. The procedure was done through a transfemoral approach, the indication for TAVR was severe AS in 97% of cases, and 72% had an Edwards SAPIEN 3 Transcatheter Heart Valve implanted. Mild PVR was seen in 191 (17.4%) patients, and the rest (82.6%) had no or trivial post-TAVR PVR. Mortality at 30-days and 1 year was similar between none/trivial and mild PVR groups (1.6% vs 1.7%, p = 0.93 & 6.3% vs 8.8%, p = 0.31). HF-related hospitalizations were the same at 30 days as well as 1 year in both groups (1.9% vs 0.8%, p = 0.209 and 4.5% vs 6.3%, p = 0.461).

Conclusion: Although mild PVR is seen in approximately one-fifth of patients after TAVR, patients with mild PVR have similar outcomes compared to those with none or trivial PVR.

Abbreviations: AR: Aortic Regurgitation; AV: Aortic Valve; HF: Heart Failure; VARC: Valve Academic Research Consortium; LVOT: Left Ventricular Outflow Tract; LVEF: Left Ventricular Ejection Fraction; PVR: Paravalvular Aortic Regurgitation; TAVR: Transcatheter Aortic Valve Replacement; TF: Transfemoral

Disclosure statement

The authors report no conflict of interest.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

The authors report no funding in support of this paper.

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