Abstract 14935: Impact of Paravalvular Regurgitation after Surgical Aortic Valve Replacement for Severe Aortic Stenosis: An Intraoperative Transesophageal Echocardiography Study

Abstract

Introduction: Greater than mild paravalvular regurgitation (PVR) is reported to worsen late mortality after transcatheter aortic valve replacement (TAVR). However the impact of PVR on the prognosis after surgical aortic valve replacement (SAVR) is not determined. The purpose of this study was to investigate the impact of PVR on the prognosis after SAVR in patients with aortic stenosis (AS) using intraoperative transesophageal echocardiography (iTEE). Hypothesis: We hypothesized that the prognosis of mild PVR after SAVR in patients with AS is benign. Methods: We retrospectively reviewed 304 consecutive patients with severe AS who underwent isolated SAVR using bioprosthesis and who had color Doppler iTEE images after SAVR. Severity of PVR was determined by the sum of the cross-sectional area of the vena contracta (VCA) using 2D color Doppler just after SAVR. Grading of PVR was determined using the following VCA cutoffs: trivial 0-4 mm2; mild 5-9 mm2; moderate 10-29 mm2; severe ≥ 30 mm2. We investigated the clinical course after SAVR including death, re-hospitalization due to heart failure exacerbation, and reoperation. Results: The patients were 76 ± 10 years old, and 57% were male. PVR was trivial in 28 patients (9%), mild in 18 (6%), moderate in 9 (3%), severe in 0. During the follow-up period of 1111 ± 582 days (median 1071 days), there were significant differences in survival between moderate and none/trivial or mild PVR group (p < 0.001 and 0.004, respectively). There was no significant differences in survival between mild and none/trivial PVR group (p = 0.69). Of 35 patients with ≥ mild PVR, only 3 patients with moderate PAR re-hospitalized for heart failure exacerbation and 1 of them resulted in successful percutaneous paravalvular leak closure. There was no other patient for reoperation except this patient. Conclusions: Although infrequent, moderate PVR showed worse survival following SAVR for severe AS, while the prognosis of mild PVR was benign.