Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications.
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Landes Uri, Hochstadt Aviram, Manevich Lisa, Webb John G, Sathananthan Janarthanan, Sievert Horst, Piayda Kerstin, Leon Martin B, Nazif Tamim M, Blusztein David, Hildick-Smith David, Pavitt Chris, Thiele Holger, Abdel-Wahab Mohamed, Van Mieghem Nicolas M, Adrichem Rik, Sondergaard Lars, De Backer Ole, Makkar Raj R, Koren Ofir, Pilgrim Thomas, Okuno Taishi, Kornowski Ran, Codner Pablo, Finkelstein Ariel, Loewenstein Itamar, Barbash Israel, Sharon Amir, De Marco Federico, Montorfano Matteo, Buzzatti Nicola, Latib Azeem, Scotti Andrea, Kim Won-Keun, Hamm Christian, Franco Luis Nombela, Mangieri Antonio, Schoels Wolfgang H, Barbanti Marco, Bunc Matjaz, Akodad Myriama, Rubinshtein Ronen, Danenberg Haim
Аннотация
METHODS AND RESULTS: A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007].
CONCLUSION: This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.