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Impact of mixed aortic valve disease in long-term mortality after transcatheter aortic valve implantation

Session Poster session 1

Speaker Konstantinos Toutouzas

Event : ESC Congress 2016

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease – Treatment
  • Session type : Poster Session

Authors : K Toutouzas (Athens,GR), K Stathogiannis (Athens,GR), M Drakopoulou (Athens,GR), G Latsios (Athens,GR), A Synetos (Athens,GR), G Trantalis (Athens,GR), O Kaitozis (Athens,GR), A Michelongona (Athens,GR), C Aggeli (Athens,GR), E Tsiamis (Athens,GR), D Tousoulis (Athens,GR)

K. Toutouzas1 , K. Stathogiannis1 , M. Drakopoulou1 , G. Latsios1 , A. Synetos1 , G. Trantalis1 , O. Kaitozis1 , A. Michelongona1 , C. Aggeli1 , E. Tsiamis1 , D. Tousoulis1 , 1Hippokration Hospital, University of Athens, 1st Department of Cardiology - Athens - Greece ,

European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 151

Background: The negative impact of significant aortic regurgitation in patients with severe aortic stenosis is well known.

Purpose: To investigate the impact of mixed aortic valve disease (MAVD) in patients undergoing transcatheter aortic valve implantation (TAVI) with a self-expanding valve.

Methods: Patients with severe and symptomatic aortic stenosis who were scheduled for TAVI were prospectively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Primary clinical end-point was 4-year all-cause mortality. All outcomes were evaluated according to the VARC-2 criteria. Patients with no aortic regurgitation (AR) were considered to have pure aortic stenosis (AS) and patients with mild/moderate/severe AR were considered to have MAVD.

Results: We included 133 patients (age: 82±8 years; logistic EuroSCORE 21±8%; 59% females; NYHA III 81%) in the study. Twenty-one patients (16%) had pure AS and 112 patients had MAVD (84%). The primary clinical end point occurred in 3 patients with pure AS and in 26 patients with MAVD (14% versus 23% respectively, p=0.5). No major differences were observed concerning cardiovascular death (10% versus 17%, p=0.5), stroke (10% versus 3%, p=0.1) and acute kidney injury (8% versus 4%, p=0.2) in pure AS and MAVD patients respectively. Post TAVI AR was higher in the MAVD group compared to the pure AS group (moderate AR: 77% vs 71% and severe AR: 12% vs 0%, p<0.007 for all measurements).

At univariate analysis, predictors for mortality were: severe AR before TAVI (p<0.03, OR: 16, 95% CI: 2.634–9.7), mean gradient >40 mmHg (p=0.24, OR: 0.369, 95% CI: 0.156–0.875), female gender (p=0.26, OR: 1.629, 95% CI: 0.691–3.838), age (p<0.04, OR: 1.091, 95% CI: 1.003–1.188) and logEuroscore (p<0.004, OR: 1.058, 95% CI: 1.018–1.099). At multivariate analysis, age (p<0.022, OR: 1.116, 95% CI: 1.018–1.224), mean gradient >40 mmHg (p<0.003, OR: 0.214, 95% CI: 0.077–0.593) and severe AR (p<0.004, OR: 18, 95% CI: 2.591–13.4) were independent predictors of long-term mortality.

Conclusions: Mixed aortic valve disease with severe aortic regurgitation before TAVI is associated with increased long-term mortality and further studies are needed in order to explore possible implications in patient selection.

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