Degree of Peri-Prosthetic Aortic Regurgitation: An Independent Predictor of Long-Term Mortality Following Transcatheter Aortic Valve Replacement

Background: Transcatheter aortic valve implantation (TAVI) has recently emerged as a promising alternative to surgical aortic valve replacement (AVR) in those patients whose surgical risk profile prevents them from undergoing an open-heart procedure. However, TAVI is not without drawbacks and potential complications. Peri-prosthetic aortic regurgitation (periAR) is a known complication of TAVI. Furthermore, moderate and severe periAR have previously been identified as independent risk factors for short- and midterm mortality following TAVI. Currently, there is very little information regarding long-term mortality in the presence of periAR following TAVI. Method: An exhaustive search of available medical literature was conducted by searching Medline-OVID, CINAHL, Web of Science, and MDConsult using the terms: long-term outcomes, transcatheter aortic valve implantation, and aortic regurgitation. Further, citations from articles were searched for additional pertinent studies. Relevant articles were assessed for quality using GRADE. Articles with primary data regarding long-term outcomes for patients with periAR following TAVI were included. Results: Two studies met inclusion criteria and were evaluated in this systematic review. One retrospective observational study with 202 patients identified moderate/severe periAR as the strongest independent risk factor of both all-cause and cardiovascular mortality at 1-year. Another retrospective observational study with 146 participants concluded that AR index/or moderate/severe degree of periAR independently predicted 1-year mortality. Conclusion: Degree of periAR and AR index both independently predict 1-year mortality following TAVI. Assessment of periAR provides additional data that can be used to more accurately determine prognosis following TA