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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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“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]
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“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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Metadata
- 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 › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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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