Postprocedural Aortic Regurgitation in Balloon-Expandable and Self-Expandable Transcatheter Aortic Valve Replacement Procedures: Analysis of Predictors and Impact on Long-Term Mortality: Insights From the FRANCE2 Registry
Abstract
Background—: Significant postprocedural aortic regurgitation (AR) is observed in 10% to 20% of cases after transcatheter aortic valve replacement (TAVR). The prognostic value and the predictors of such a complication in balloon-expandable (BE) and self-expandable (SE) TAVR remain unclear. Methods and Results—: TAVR was performed in 3195 consecutive patients at 34 hospitals. Postprocedural transthoracic echocardiography was performed in 2769 (92%) patients of the eligible population, and these patients constituted the study group. Median follow-up was 306 days (Q1–Q3=178–490). BE and SE devices were implanted in 67.6% (n=1872) and 32.4% (n=897). Delivery was femoral (75.3%) or nonfemoral (24.7%). A postprocedural AR≥grade 2 was observed in 15.8% and was more frequent in SE (21.5%) than in BE-TAVR (13.0%, P =0.0001). Extensive multivariable analysis confirmed that the use of a SE device was one of the most powerful independent predictors of postprocedural AR≥grade 2. For BE-TAVR, 8 independent predictors of postprocedural AR≥grade 2 were identified including femoral delivery ( P =0.04), larger aortic annulus ( P =0.0004), and smaller prosthesis diameter ( P =0.0001). For SE-TAVR, 2 independent predictors were identified including femoral delivery( P =0.0001). Aortic annulus and prosthesis diameter were not predictors of postprocedural AR for SE-TAVR. A postprocedural AR≥grade 2, but not a postprocedural AR=grade 1, was a strong independent predictor of 1-year mortality for BE (hazard ratio=2.50; P =0.0001) and SE-TAVR (hazard ratio=2.11; P =0.0001). Although postprocedural AR≥grade 2 was well tolerated in patients with AR≥grade 2 at baseline (1-year mortality=7%), it was associated with a very high mortality in other subgroups: renal failure (43%), AR<grade 2 at baseline (31%), low transaortic gradient (35%), or nonfemoral delivery (45%). Conclusions—: Postprocedural AR≥grade 2 was observed in 15.8% of successful TAVR and was the strongest independent predictor of 1-year mortality. The use of the SE device was a powerful independent predictor of postprocedural AR≥grade 2.
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Some studies suggest that the adverse association between paravalvular aortic regurgitation and mortality extends to mild regurgitation.
“with some studies even suggesting that this adverse association extends to mild regurgitation235;237;238.”
From Calcific aortic stenosis (2016) · cites this paper as [238]
In “Impact of AR on Mortality” (page unavailable), this study reports no association between mild (grade 1) postprocedural regurgitation and total or cardiovascular mortality. The “Incidence and Predictive Value of AR on One-Year Mortality” section acknowledges that the PARTNER study and a prior meta-analysis differed, but this paper’s own finding is contrary to the claim for which it is cited. (LLM, conf=0.89)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe association between moderate or severe paravalvular aortic regurgitation and increased mortality is clearly established.
“The association between moderate or severe paravalvular aortic regurgitation and increased mortality has been clearly established”
From Calcific aortic stenosis (2016) · cites this paper as [238]
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- Authors
- Van Belle, E., Juthier, F., Susen, S., Vincentelli, A., Iung, B., Dallongeville, J., Eltchaninoff, H., Laskar, M., Leprince, P., Lievre, M., Banfi, C., Auffray, J.-L., Delhaye, C., Donzeau-Gouge, P., Chevreul, K., Fajadet, J., Leguerrier, A., Prat, A., Gilard, M., & Teiger, E.
- Affiliations
- From the Department of Cardiology, University Hospital, Lille, France (E.V.B., F.J., A.V., C.B., J.-L.A., C.D., A.P.); EA2693, Lille-II-University, Lille, France (E.V.B., F.J., S.S., A.V., C.B., J.-L.A., C.D., A.P.); INSERM-U744, Lille, France (J.D.); CHU Bichat, Paris, France (B.I.); CHU Rouen, Rouen, France (H.E.); CHU Dupuytren, Limoges, France (M. Laskar); CHU Pitié–Salpêtrière, Paris, France (P.L.); University Lyon-1, Lyon, France (M. Lievre; Institut cardiovasculaire Paris-Sud, Paris, France ...
- Inserm (FR)
- ORCID
- Venue
- Circulation
- Published
- 2014-04
- Volume
- 129
- Issue
- 13
- Pages
- 1415-1427
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2025529577
- Cited by
- 241
- References
- 28
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 9 · 2023: 13 · 2022: 19 · 2021: 12 · 2020: 31 · 2019: 18 · 2018: 22 · 2017: 22 · 2016: 25 · 2015: 37 · 2014: 13
- FWCI
- 22.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- 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
- transcatheter aortic valve implantation, balloon-expandable valves, self-expanding valves, aortic annulus size, transfemoral access, one-year mortality
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve, Aortic Valve Insufficiency, Aortic Valve Stenosis, Echocardiography, Female, Follow-Up Studies, France, Heart Valve Prosthesis, Humans, Longitudinal Studies, Male, Postoperative Complications, Predictive Value of Tests, Prognosis, Registries, Time Factors, Incidence, Survival Rate, Treatment Outcome, Heart Valve Prosthesis Implantation, Balloon Valvuloplasty
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