Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:233

Article

Colli, Andrea¹  Besola, Laura¹  Salizzoni, Stefano²  Gregori, Dario¹  Tarantini, Giuseppe¹  Agrifoglio, Marco³  Chieffo, Alaide⁴  Regesta, Tommaso⁵  Gabbieri, Davide⁶  Saia, Francesco⁷  Tamburino, Corrado⁸  Ribichini, Flavio⁹  Valsecchi, Orazio¹⁰  Loi, Bruno¹¹  Iadanza, Alessandro¹²  Stolcova, Miroslava¹³  Minati, Alessandro¹⁴  Martinelli, Gianluca¹⁵  Bedogni, Francesco¹⁶  Petronio, Anna¹⁷  Dallago, Michele¹⁸  Cappai, Antioco¹⁹  D'Onofrio, Augusto¹  Gerosa, Gino¹  Rinaldi, Mauro² 

[1] Univ Padua, Dept Cardiol Thorac & Vasc Sci, Padua, Italy

[2] Univ Turin, San Giovanni Battista Hosp Molinette, Div Cardiac Surg, Turin, Italy

[3] Univ Milan, Ctr Cardiol, Dept Clin Sci & Community Hlth, Cardiac Surg,Monzino Hosp, Milan, Italy

[4] Ist Sci San Raffaele, Div Metab & Cardiovasc Sci, Milan, Italy

[5] Univ Genoa, San Martino Univ Hosp, Div Cardiac Surg, Genoa, Italy

[6] Hesperia Hosp, Clin Surg Cardiol & Thorac Vasc Dept, Modena, Italy

[7] Univ Bologna, Dept Cardiol, Policlin S Orsola Malpighi, Bologna, Italy

[8] Ferrarotto Hosp, Div Cardiol, Catania, Italy

[9] Univ Verona, Div Cardiol, Dept Med, Verona, Italy

[10] AO Papa Giovanni XXIII, Cardiovasc Dept, Bergamo, Italy

[11] AO Brotzu, Intervent Cardiol Unit, Cagliari, Italy

[12] Univ Siena, Le Scotte Univ Hosp, Dept Cardiovasc Dis, Siena, Italy

[13] Careggi Univ Hosp, Intervent Cardiol Unit, Florence, Italy

[14] Azienda Osped Univ, Div Cardiac Surg, Trieste, Italy

[15] Santa Maria Hosp, Div Cardiac Surg, Bari, Italy

[16] Clin Inst S Ambrogio, Dept Cardiol, Milan, Italy

[17] Azienda Osped Univ Pisana, Pisa, Italy

[18] Santa Chiara Hosp, Div Cardiol, Trento, Italy

[19] Humanitas Res Hosp, Div Cardiac Surg, Milan, Italy

关键词: TAVI;    TAVR;    Paravalvular leakage;    Aortic valve regurgitation;    Aortic valve stenosis;   

DOI  :  10.1016/j.ijcard.2017.02.005

来源: Elsevier

【 摘 要 】

Objective: The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes. Methods and results: We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate-severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821 days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9-2.05, p = 0.012 for mild PVL, HR 1.36, CI 95% 0.9-2.05, p < 0.001 for PVL >= moderate and OR 1.04, p = 0.97 respectively). Patients with moderate-severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi > 75 ml/m(2)) showed better survival than those without dilatation (HR 8.63, p - 0.001). Conclusions: In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages. (C) 2017 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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