Analysis of the Incidence and Clinical and Echocardiographic Predictors of Paravalvular Aortic Regurgitation after Transcatheter Aortic Valve Implantation

ABSTRACTBackgroundThe incidence of paravalvular aortic regurgitation (PAR) seems higher among patients submitted to transcatheter aortic valve implantation and its potential association with an increased late mortality has raised concerns in the scientific community. Our objective was to evaluate the incidence and clinical impact of PAR and establish PAR predictors in our patient population.MethodsBetween July/2009 and February/ 2013, 112 patients were submitted to transcatheter aortic valve implantation. The degree of PAR after the procedure was assessed according to the VARC 2 criteria. The population was divided into no/mild PAR group and moderate/severe PAR group.ResultsMean age was 82.5+3.9 years, 58.9% were female and the logistic EuroSCORE was 23.6±13.4. There was a decrease in the mean systolic gradient (54.7 ± 15.3mmHg vs 11.7 ± 4 mmHg; P < 0.01) and a gain in the aortic valve area (0.66±0.15cm2 vs 1.8 ± 0.3cm2; P < 0.01). At the end of the procedure 46.4% did not have PAR, and mild or moderate PAR was observed in 42% and 11.6% of the patients. No patient presented severe PAR. Multivariate analysis identified male gender [odds ratio (OR) 5.85, confidence interval (CI] 1.29-26.7; P = 0.022), previous percutaneous aortic valvuloplasty (OR 18.44, CI 2.30-147.85; P = 0.006), ejection fraction < 35% (OR 4.160, CI 1.014-17.064; P = 0.048) and the presence of severe pulmonary hypertension (OR 7.649, CI 1.86-31.51; P = 0.005) as independent predictors of moderate/ severe PAR.ConclusionsThe incidence of moderate/severe PAR was low and comparable to other studies. Male gender, history of prior percutaneous aortic valvuloplasty, presence of severe pulmonary hypertension and severe left ventricular dysfunction were independent predictors of this complication