Document Detail


Incidence, Predictors and Outcomes of Aortic Regurgitation after Transcatheter Aortic Valve Replacement: Meta-analysis and Systematic Review of Literature.
MedLine Citation:
PMID:  23500308     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Aortic regurgitation (AR) is an important limitation of transcatheter aortic valve replacement (TAVR) with ill-defined predictors and unclear long term impact on outcomes. We sought to analyze currently published literature to establish the incidence, impact and predictors of post TAVR AR. METHODS AND RESULTS: Studies published between 2002 and 2012 with regards to TAVR were identified using an electronic search and reviewed using the random effects model of DerSimonian and Laird. From 3871 initial citations, 45 studies reporting on 12,926 patients (CoreValve 5,261 and Edward's valve 7,279) were included in the analysis of incidence and outcomes of post TAVR AR. The pooled estimate for moderate or severe AR post TAVR was 11.7% (95% CI 9.6% to 14.1%). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p =0.005). The presence of moderate or severe AR post TAVR increased mortality at 30 days (OR 2.95, 95% CI 1.73- 5.02) and at 1 year, (HR 2.27, 95% CI - 1.84-2.81). Mild AR was also associated with an increased hazard for mortality (HR 1.829, 95% CI 1.005-3.329) that was however overturned by sensitivity analysis. Twenty five studies reported on predictors of post TAVR AR. Implantation depth, valve under sizing and Agatston calcium score (r=0.47, p = 0.001) were identified as important predictors. CONCLUSION: Moderate or severe aortic regurgitation is common after TAVR and is an adverse prognostic indicator of short and long term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long term mortality. Every effort should therefore be made to minimize AR by a comprehensive pre procedural planning and meticulous procedural execution.
Authors:
Ganesh Athappan; Eshan Patvardhan; E Murat Tuzcu; Lars Georg Svensson; Pedro A Lemos; Chiara Fraccaro; Giuseppe Tarantini; Jan-Malte Sinning; Georg Nickenig; Davide Capodanno; Corrado Tamburino; Azeem Latib; Antonio Colombo; Samir R Kapadia
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-3-13
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  -     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-3-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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