0546: Aortic paravalvular regurgitation after transcatheter valve implantation is associated with worse prognosis

Abstract

Aortic stenosis (AS) is increasing in incidence with the aging of the population. Transcatheter Aortic Valve Implantation (TAVI) provides a therapeutic option for patients with severe AS who are high risk surgical candidates A large proportion of patients undergoind TAVI have at least mild aortic paravalvular regurgitation (APR) following the procedure. The purpose of this study was to determine the clinical and prognostic significance of paravalvular regurgitation early after TAVI. Hundred and five patients who underwent TAVI at our center from 9.2008 to 5.2012 were studied retrospectively. Echocardiography before and following the procedure but prior to discharge were reviewed. Aortic and mitral regurgitations were assessed using semi quantitative methods. Among 105 patients who underwent TAVI, twenty four (23%) had significant (moderate and more) APR and eighty one (77%) had non significant (less than moderate) APR. There was not significant difference in the baseline characteristics of the two groups (age, sex, left ventricular ejection fraction, aortic valve area, aortic ventricular gradient, ischemic heart disease, pre-procedural aortic regurgitation). Mean follow up was up to 19 months. The mortality rate was higher in the group with significant PAR as compared with the group without APR (29% versus 11% p<0.009). The frequency of develop block was more frequent in this group (47% versus 30%, p<0.205). Worsening of Mitral regurgitation was more frequent in the significant APR group (71% versus 17%, P<0.001) as worsening of pulmonary hypertension (21% versus 4%, P<0.001). Significant paravalvular aortic regurgitation after TAVI causes worsening of mitral regurgitation and pulmonary hypertension and seems associated with higher risk of pacemaker implantation and mortality. Paravalvular aortic regurgitation has clinical significance beyond the often minimal hemodynamic effects after TAVI.