Progression and Prognosis of Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Abstract Background: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) remains uncertain. Objective: To evaluate the impact of PVR on mortality and hospital readmission one year after TAVI. Methods: Between January 2009 and June 2015, a total of 251 patients underwent TAVI with three different prostheses at two cardiology centers. Patients were assessed according to PVR severity after the procedure. Results: PVR was classified as absent/trace or mild in 92.0% (n = 242) and moderate/severe in 7.1% (n = 18). The moderate/severe PVR group showed higher levels of aortic calcification (22% vs. 6%, p = 0.03), higher serum creatinine (1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014), lower aortic valve area (0.6 ± 0.1 vs. 0.7 ± 0.2 cm2, p = 0.05), and lower left ventricular ejection fraction (49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009). Patients with moderate/severe PVR had more need for post-dilatation (p = 0.025) and use of larger-diameter balloons (p = 0.043). At one year, all-cause mortality was similar in both groups (16.7% vs. 12%, p = 0.08), as well as rehospitalization (11.1% vs. 7.3%, p = 0.915). PVR grade significantly reduced throughout the first year after the procedure (p < 0.01). The presence of moderate/severe PVR was not associated with higher one-year mortality rates (HR: 0.76, 95% CI: 0.27-2.13, p = 0.864), rehospitalization (HR: 1.08, 95% CI: 0.25-4.69, p=0.915), or composite outcome (HR: 0.77, 95% CI: 0.28-2.13, p = 0.613). Conclusion: In this sample, moderate/severe PVR was not a predictor of long-term mortality or rehospitalization. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

背景：经导管主动脉瓣置换术（transcatheter aortic valve implantation, TAVI）后出现的交界旁反流（paravalvular regurgitation, PVR）的临床影响仍不明确。目的：评估TAVI术后1年内，PVR对患者死亡率及住院再入院率的影响。方法：2009年1月至2015年6月期间，两家心脏中心共251例患者接受了三种不同人工瓣膜的TAVI手术，术后根据PVR严重程度对患者进行分组评估。结果：92.0%（n = 242）的患者术后PVR为无/微量或轻度，7.1%（n = 18）为中度/重度。中度/重度PVR组患者的主动脉钙化比例更高（22% vs. 6%, p = 0.03）、血清肌酐水平更高（1.5 ± 0.7 vs. 1.2 ± 0.4 mg/dL, p = 0.014）、主动脉瓣面积更小（0.6 ± 0.1 vs. 0.7 ± 0.2 cm², p = 0.05）、左心室射血分数更低（49.2 ± 14.8% vs. 58.8 ± 12.1%, p = 0.009）。中度/重度PVR组患者更需要接受术后球囊扩张（p = 0.025）及使用更大直径的球囊（p = 0.043）。术后1年时，两组患者的全因死亡率（16.7% vs. 12%, p = 0.08）及再住院率（11.1% vs. 7.3%, p = 0.915）均无显著差异。术后1年内，PVR分级显著降低（p < 0.01）。中度/重度PVR与更高的1年全因死亡率（风险比[HR]: 0.76, 95%置信区间[CI]: 0.27-2.13, p = 0.864）、再住院率（HR: 1.08, 95%CI: 0.25-4.69, p=0.915）或复合终点事件（HR: 0.77, 95%CI: 0.28-2.13, p = 0.613）均无关联。结论：本研究样本中，中度/重度PVR并非长期死亡率或再住院率的预测因素。（《Arq Bras Cardiol》. 2017; [网络版预印], PP.0-0）