October 1, 2014
View Full PaperCoreValve implantation for severe aortic regurgitation: a multicentre registry
Structured PICO
Does TAVR with the CoreValve Revalving System result in similar outcomes for inoperable patients with severe aortic regurgitation compared to those with severe aortic stenosis?
P
Population
1,557 consecutive inoperable patients undergoing transcatheter aortic valve replacement, including 26 (1.6%) with severe aortic regurgitation and the remainder with severe native aortic stenosis.
I
Intervention
Transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System for severe aortic regurgitation.
C
Comparator
Transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System for severe native aortic stenosis.
O
Outcome
VARC-2-defined device success, overall mortality, and cardiac mortality at 1 month and 12 months.hard clinical
TAVR with the CoreValve system for severe aortic regurgitation is associated with significantly higher mortality and lower device success compared to its use for severe aortic stenosis, though it may still be a reasonable option for selected inoperable patients.
Abstract
AIMS: We sought to evaluate the outcome of transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in inoperable patients presenting with severe aortic regurgitation (AR), compared to in patients treated for severe native aortic stenosis (AS). From October 2008 to January 2013, 1,557 consecutive patients undergoing CRS-TAVR, of whom 26 (1.6%) presented with AR, were prospectively followed. Compared with patients with AS, patients with AR were significantly younger (mean age 73±10 vs. 82±6, p=0.02), more frequently in NYHA Class III/IV (95% vs. 73%, p=0.01) and had a higher incidence of severe pulmonary hypertension (sPAP >60 mmHg, 31% vs. 10%, p=0.007). Log EuroSCORE and STS score were similar. VARC-2-defined device success was lower in the AR group (79% vs. 96%, p=0.006). At one month, patients treated for AR had a higher overall mortality (23% vs. 5.9%; OR 4.22 3.03-8.28, p<0.001) and cardiac mortality (15.3% vs. 4%, OR 4.01 2.40-7.66, p<0.001). Results were consistent at 12 months: overall mortality (31% vs. 19%, HR 2.1 1.5-4.41, p<0.001) and cardiac mortality (19.2% vs. 6%, HR 3.1 2.09-8.22, p<0.001). CRS-TAVR for AR is associated with a significantly higher mortality compared to CRS-TAVR for AS. Considering the ominous prognosis of these patients when treated medically, TAVR may be a reasonable choice in selected patients. In this regard, conventional risk scores have an inadequate predictive value.