Predictors of Aortic Regurgitation After TAVR Delineated

MUNICH, Germany—The presence of subannular aortic calcification and a pattern of diffuse calcium distribution in the coronary cusps both predict substantial levels of valvular regurgitation after transcatheter aortic valve replacement (TAVR), according to results presented on August 26, 2012, at the European Society of Cardiology (ESC) Congress 2012.

Javier Suárez de Lezo Jr, MD, of Hospital de Las Palmas de Gran Canaria (Las Palmas de Gran Canaria, Spain), and colleagues analyzed clinical data from 153 patients with aortic stenosis who underwent TAVR with the CoreValve prosthesis (Medtronic, Minneapolis, MN) between April 2008 and December 2011.

Two Regurgitation Predictors Found

Procedural success was 99%. Balloon post-dilation was required in 59 (38%) patients due to substantial aortic regurgitation, defined as grade II or above; the treatment reduced the degree of regurgitation in 40 of these cases (68%). After TAVR, substantial aortic regurgitation was observed in 33 patients (n = 27 with grade II; n = 6 with grade III). Grade I aortic regurgitation, defined as mild, was seen in 75 patients (44%), and 44 patients (29%) were free of residual regurgitation.

The depth of the prosthesis was similar in patients with and without substantial aortic regurgitation (11.1 ± 3 mm vs. 10.7 ± 4 mm; P = 0.4). Although the annuli of 31% of patients were asymmetric, defined as having a symmetry index ≤ 0.8, and 69% were symmetric, this parameter also had no impact on the incidence of substantial aortic regurgitation (P = 0.4).

However, the presence of subannular calcification on CT scan did predict the development of regurgitation. In the 44% of patients with calcification, substantial regurgitation appeared after TAVR (P < 0.01). Five of the 6 patients with grade III regurgitation showed subannular calcification. In addition, 18% of patients with substantial regurgitation had diffuse calcium distribution (P < 0.05).

Device ‘Bias’

As the study only used CoreValve, Dr. Suárez de Lezo said it remains to be seen if the same findings would occur with the Sapien device (Edwards Lifesciences, Irvine, CA). “The problem with regurgitation in these patients is related to expansion of the frame of the valve,” a factor that could be device-specific, he said.

Calling the results “biased,” session co-chair Francesco Maisano, MD, of San Raffaele Hospital (Milan, Italy) said “the issue of aortic regurgitation is still open for additional studies.”

Study Details

Baseline characteristics were similar for all patients. The average age was 77 years, and 58% were female.

 

Source:

Suárez de Lezo J. Factors influencing significant aortic regurgitation after transcatheter aortic valve implantation in patients with severe aortic stenosis. Presented at: European Society of Cardiology Congress; August 26, 2012; Munich, Germany.

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Predictors of Aortic Regurgitation After TAVR Delineated

MUNICH, Germany—The presence of subannular aortic calcification and a pattern of diffuse calcium distribution in the coronary cusps both predict substantial levels of valvular regurgitation after transcatheter aortic valve replacement (TAVR), according to results presented on August 26, 2012, at
Disclosures
  • Dr. de Lezo reports no related conflicts of interest.

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