Postprocedural Aortic Regurgitation in Balloon- Expandable and Self- Expandable Transcatheter Aortic Valve Replacement Procedures Analysis of Predictors and Impact on Long- Term Mortality: Insights From the FRANCE2 Registry
Postprocedural Aortic Regurgitation in Balloon- Expandable and Self- Expandable Transcatheter Aortic Valve Replacement Procedures Analysis of Predictors and Impact on Long- Term Mortality: Insights From the FRANCE2 Registry
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DOI：
10.1161/circulationaha.113.002677
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发表时间：
2014-04-01
期刊：
影响因子：
37.8
通讯作者：
Teiger, Emmanuel
中科院分区：
文献类型：
--
作者：
Van Belle, Eric;Juthier, Francis;Teiger, Emmanuel
Background Significant postprocedural aortic regurgitation (AR) is observed in 10% to 20% of cases after transcatheter aortic valve replacement (TAVR). The prognostic value and the predictors of such a complication in balloon-expandable (BE) and self-expandable (SE) TAVR remain unclear.Methods and Results TAVR was performed in 3195 consecutive patients at 34 hospitals. Postprocedural transthoracic echocardiography was performed in 2769 (92%) patients of the eligible population, and these patients constituted the study group.中位随访时间为 306 天（Q1-Q3=178-490）。 BE 和 SE 装置的植入率为 67.6% (n=1872) 和 32.4% (n=897)。分娩方式为股骨分娩（75.3%）或非股骨分娩（24.7%）。术后 AR 2 级发生率为 15.8%，SE 中 (21.5%) 的发生率高于 BE-TAVR (13.0%，P=0.0001)。 Extensive multivariable analysis confirmed that the use of a SE device was one of the most powerful independent predictors of postprocedural ARgrade 2. For BE-TAVR, 8 independent predictors of postprocedural ARgrade 2 were identified including femoral delivery (P=0.04), larger aortic annulus (P=0.0004), and smaller prosthesis diameter (P=0.0001).对于 SE-TAVR，确定了 2 个独立的预测因素，包括股动脉分娩（P=0.0001）。主动脉瓣环和假体直径不是 SE-TAVR 术后 AR 的预测因素。 A postprocedural ARgrade 2, but not a postprocedural AR=grade 1, was a strong independent predictor of 1-year mortality for BE (hazard ratio=2.50; P=0.0001) and SE-TAVR (hazard ratio=2.11; P=0.0001). Although postprocedural ARgrade 2 was well tolerated in patients with ARgrade 2 at baseline (1-year mortality=7%), it was associated with a very high mortality in other subgroups: renal failure (43%), AR
Background Significant postprocedural aortic regurgitation (AR) is observed in 10% to 20% of cases after transcatheter aortic valve replacement (TAVR). The prognostic value and the predictors of such a complication in balloon-expandable (BE) and self-expandable (SE) TAVR remain unclear.Methods and Results TAVR was performed in 3195 consecutive patients at 34 hospitals. Postprocedural transthoracic echocardiography was performed in 2769 (92%) patients of the eligible population, and these patients constituted the study group. Median follow-up was 306 days (Q1-Q3=178-490). BE and SE devices were implanted in 67.6% (n=1872) and 32.4% (n=897). Delivery was femoral (75.3%) or nonfemoral (24.7%). A postprocedural ARgrade 2 was observed in 15.8% and was more frequent in SE (21.5%) than in BE-TAVR (13.0%, P=0.0001). Extensive multivariable analysis confirmed that the use of a SE device was one of the most powerful independent predictors of postprocedural ARgrade 2. For BE-TAVR, 8 independent predictors of postprocedural ARgrade 2 were identified including femoral delivery (P=0.04), larger aortic annulus (P=0.0004), and smaller prosthesis diameter (P=0.0001). For SE-TAVR, 2 independent predictors were identified including femoral delivery(P=0.0001). Aortic annulus and prosthesis diameter were not predictors of postprocedural AR for SE-TAVR. A postprocedural ARgrade 2, but not a postprocedural AR=grade 1, was a strong independent predictor of 1-year mortality for BE (hazard ratio=2.50; P=0.0001) and SE-TAVR (hazard ratio=2.11; P=0.0001). Although postprocedural ARgrade 2 was well tolerated in patients with ARgrade 2 at baseline (1-year mortality=7%), it was associated with a very high mortality in other subgroups: renal failure (43%), AR