TY - JOUR
AU - Werner, N.
AB - Background: Paravalvular Aortic Regurgitation (PAR) negatively impacts the prognosis following Transcatheter Aortic Valve Implantation (TAVI). A multi-modal approach for the evaluation of PAR with use of hemodynamic measurements and imaging modalities is imperative to identify patients who will benefit from corrective measures such as post-dilation or valve-in-valve implantation.Methods: The severity of PAR was evaluated in 303 TAVI patients by angiography, echocardiography, and the assessment of hemodynamics. The Aortic Regurgitation (AR) Index has been calculated retrospectively in the first 146 patients of this TAVI cohort (retrospective cohort). A cut-off value of 25 was the best predictor for both: the occurrence of more-than-mild PAR and 1-year all-cause mortality. This AR index cut-off value was evaluated prospectively (see figure) to manage PAR after TAVI in the prospective cohort (N=157).Results: Based on the AR Index, the occurrence of more-than-mild PAR in the prospective cohort (N=157; logistic EuroSCORE of 24.4±15.2%) could be reduced significantly compared to the retrospective cohort (N=146) (6.9% vs. 15.1%; p=0.026), whereas the post-dilation rate was not significantly different (35.2% vs. 27.4%; p=0.15). By use of post-dilation, the AR index could be increased from 17.8±5.0 to 27.6±7.5 (p<0.001) in 50/145 patients with significant PAR after initial deployment of the valve without excess of stroke risk (2.0% vs. 1.1%; p=0.65). The 30-day mortality rate showed a benefical trend in favor of the prospective cohort (3.4% vs. 6.8%; p=0.19).Algorithm for the Management of PARConclusion: A multimodal algorithm considering hemodynamics in addition to imaging modalities was useful to identify patients with significant PAR after TAVI and helped to reduce the procedure-related rate of paravalvular leakage.
TI - Prospective evaluation of the aortic regurgitation index in TAVI patients
JO - European Heart Journal
DO - 10.1093/eurheartj/eht310.P5398
DA - 2013-08-01
UR - https://www.deepdyve.com/lp/oxford-university-press/prospective-evaluation-of-the-aortic-regurgitation-index-in-tavi-etuOm8BYjy
SP - P5398
VL - 34
IS - suppl_1
DP - DeepDyve
ER -