How Atrioventricular Regurgitation Affects the Outcome and Survival of your TAVI Patient. Data from the Vienna Cardiothoracic Aortic Valve Registry (VICTORY)

Markus Mach, Bernhard Winkler, David Santer, Harald Pisarik, Gabriel Weiss, Martin Grabenwöger

Hospital Hietzing, Department of Cardiovascular Surgery, Vienna, Austria

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–C

Abstract

Background:

Currently there is limited data on the change of AV-Regurgitation after TAVI, thus the aim of this study was to investigate its importance as a risk factor for adverse clinical outcomes and mortality in patients selected for either transapical (TA) or transfemoral (TF) TAVI.

Methods:

TR and MR changes were assessed in 279 patients before and after TAVI by comparing TEE and assessed by visual inspection and color-flow Doppler. 

Results:

After the procedure, the number of patients suffering from MR was significantly reduced in both cohorts TF: 90.4% to 62.6% (p<0.001) TA: 87.6% to 53.4% (p<0.001). 48.2% with mod./severe MR had improved in the TF-cohort vs. 67.3% in the TA-cohort (p=0.032).

Even though TR improvement after TAVI was insignificant, patients with mod./severe TR tended to show more improvement when treated transapically (TA 26.4% to 17.6%, p=0.056 vs. TF 26.8% to 18.9%, p=0.568).

No significant differences were shown between groups concerning the post-procedural complications defined according the VARC-2 criteria and the 30-day mortality but longterm survival was significantly reduced in patients without improvement of concomitant TR (log rank p=0.021) and MR (log rank p=0.033). Patients with residual isolated mod/severeTR are associated with increased 1 year mortality (unadjusted HR; 2,80; 95% CI; 0,91-4,46;) opposed to those with mod/severe TR and MR (undadjusted HR; 1,08; 95%CI; 1,20-2,46).

Conclusion:

Long term follow up showed a significant survival benefit in those patients with reduced TR and MR after TAVI. Therefore, concomitant MR and TR need to be obsereved closely after TAVI and treated accordingly if no improvement is seen during follow-up for optimal clinical benefit. These findings have to be confirmed in a larger multi-center study.