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

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 AR≥grade 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 AR≥grade 2. For
BE-TAVR, 8 independent predictors of postprocedural AR≥grade 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 AR≥grade
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 AR≥grade 2
was well tolerated in patients with AR≥grade 2 at baseline (1-year
mortality=7%), it was associated with a very high mortality in other
subgroups: renal failure (43%), AR

CONCLUSIONS:

Postprocedural
AR≥grade 2 was observed in 15.8% of successful TAVR and was the
strongest independent predictor of 1-year mortality. The use of the SE
device was a powerful independent predictor of postprocedural AR≥grade
2.