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Incidence, outcome and correlates of residual paravalvular aortic regurgitation after transcatheter aortic valve implantation and importance of haemodynamic assessment.
MedLine Citation:
PMID:  23256946     Owner:  NLM     Status:  Publisher    
Aims: Residual paravalvular aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) is common. We therefore evaluated incidence, determinants and outcome of PAR after TAVI. Methods and results: Data from 167 consecutive transcatheter TAVI patients were analysed. PAR was graded by angiography and the pressure gradient between diastolic aortic pressure and left ventricular end-diastolic pressure (ΔPDAP-LVEDP) after implantation. TAVI was technically successful in all patients. Mortality was 9% and 20% at 30 days and one year, respectively. Post-procedural PAR was absent in 54 patients (32.3%). Mild PAR was found in 89 (53.3%), moderate in 21 (12.6%), and moderate-to-severe in three patients (1.8%). Cardiovascular mortality at 30 days and one year was increased in patients with moderate and moderate-to-severe PAR compared to patients with no and mild PAR (46% vs. 4% and 73% vs. 7%, respectively, p<0.001). Receiver operating characteristic curve analysis suggested ΔPDAP-LVEDP ≤18 mmHg as a novel predictor of mortality, with an area under the curve of 0.97. Conclusions: In patients undergoing TAVI, moderate and moderate-to-severe PAR was observed in 14.4% and associated with increased cardiovascular mortality. A pressure gradient ΔPDAP-LVEDP≤18 mmHg carries adverse prognosis and requires further intervention.
Polykarpos C Patsalis; Thomas F M Konorza; Fadi Al-Rashid; Björn Plicht; Matthias Riebisch; Daniel Wendt; Matthias Thielmann; Heinz Jakob; Holger Eggebrecht; Gerd Heusch; Raimund Erbel; Philipp Kahlert
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-21
Journal Detail:
Title:  EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology     Volume:  -     ISSN:  1969-6213     ISO Abbreviation:  EuroIntervention     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101251040     Medline TA:  EuroIntervention     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Cardiology, West German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany.
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