Incidence, Predictors, and Outcomes of Aortic Regurgitation After Transcatheter Aortic Valve Replacement
Open accessAbstract
Objectives This study was designed to establish the incidence, impact, and predictors of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR).Background AR is an important limitation of TAVR with ill-defined predictors and unclear long-term impact on outcomes.Methods Studies published between 2002 and 2012 with regard to TAVR were identified using an electronic search and reviewed using the random-effects model of DerSimonian and Laird. From 3,871 initial citations, 45 studies reporting on 12,926 patients (CoreValve [Medtronic CV Luxembourg S.a.r.l., Tolochenaz, Switzerland] n = 5,261 and Edwards valve [Edwards Lifesciences, Santa Ana, California] n = 7,279) were included in the analysis of incidence and outcomes of post-TAVR AR.Results The pooled estimate for moderate or severe AR post-TAVR was 11.7% (95% confidence interval [CI]: 9.6 to 14.1). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p = 0.005). The presence of moderate or severe AR post-TAVR increased mortality at 30 days (odds ratio: 2.95; 95% CI: 1.73 to 5.02) and 1 year (hazard ratio: 2.27; 95% CI: -1.84 to 2.81). Mild AR was also associated with an increased hazard ratio for mortality, 1.829 (95% CI: 1.005 to 3.329) that was overturned by sensitivity analysis. Twenty-five studies reported on predictors of post-TAVR AR. Implantation depth, valve undersizing, and Agatston calcium score (r = 0.47, p = 0.001) were identified as important predictors.Conclusions Moderate or severe aortic regurgitation is common after TAVR and an adverse prognostic indicator of short- and long-term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long-term mortality. Therefore, every effort should be made to minimize AR by a comprehensive pre-procedural planning and meticulous procedural execution.
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The most notable complication of TAVR has been paravalvular aortic regurgitation.
“The most notable has been paravalvular aortic regurgitation234–236.”
From Calcific aortic stenosis (2016) · cites this paper as [234]
The Background calls aortic regurgitation an important limitation of TAVR, and the Conclusions describe it as a frequent complication with adverse prognostic implications. The paper discusses paravalvular leak, but does not establish that it is the most notable TAVR complication; its study limitations also say that paravalvular and valvular regurgitation were not precisely distinguished. (LLM, conf=0.83)
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Self-citation
- Authors
- Athappan, G., Patvardhan, E., Tuzcu, E. M., Svensson, L. G., Lemos, P. A., Fraccaro, C., Tarantini, G., Sinning, J.-M., Nickenig, G., Capodanno, D., Tamburino, C., Latib, A., Colombo, A., & Kapadia, S. R.
- Affiliations
- Cleveland Clinic (US)
- Hospital Sírio-Libanês (BR)
- University of Padua (IT)
- University Hospital Bonn (DE)
- University of Catania (IT)
- IRCCS Ospedale San Raffaele (IT)
- Corresponding author
- Kapadia, Samir R.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 61
- Issue
- 15
- Pages
- 1585-1595
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W207532508
- Cited by
- 782
- References
- 29
- Citations by year
- 2026: 23 · 2025: 32 · 2024: 27 · 2023: 45 · 2022: 42 · 2021: 56 · 2020: 57 · 2019: 68 · 2018: 83 · 2017: 87 · 2016: 86 · 2015: 88 · 2014: 61 · 2013: 26
- FWCI
- 58.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- aortic regurgitation, transcatheter aortic valve implantation, CoreValve, mortality, implantation depth, Agatston calcium score, long-term survival, prosthetic heart valve complications, paravalvular leak, aortic annulus calcification, aortic valve prosthesis
- MeSH terms
- Aortic Valve, Aortic Valve Insufficiency, Aortic Valve Stenosis, Data Collection, Cardiac Catheterization, Heart Valve Prosthesis, Humans, Postoperative Complications, Prosthesis Design, Prosthesis Failure, Risk Factors, Severity of Illness Index, Incidence, Treatment Outcome, Risk Assessment, Equipment Failure Analysis, Heart Valve Prosthesis Implantation, Kaplan-Meier Estimate
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