Impact of paravalvular regurgitation on the mid-term outcome after transcatheter and surgical aortic valve replacement
Key result
Mild PVR after TAVR is linked to ~64% higher mortality risk versus none-to-trace PVR.
- adjusted HR 1.64
- 95% CI 1.35-1.99
- n=6,463
Why the study?
The study was conducted to evaluate the incidence and prognostic impact of paravalvular regurgitation on outcomes after TAVR and SAVR for aortic stenosis.
Does mild or moderate-to-severe paravalvular regurgitation reduce 4-year survival in patients undergoing TAVR or SAVR for aortic stenosis?
Population
6463 consecutive patients undergoing TAVR or SAVR with a bioprosthesis for aortic stenosis
Comparison
Mild or moderate-to-severe PVR vs none-to-trace PVR at discharge
Design
Nationwide registry multicentre cohort study
Follow-up
4-year
Authors
Discussion
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Member takes
Implication
Mild PVR after TAVR may worsen survival; leaves open whether minimizing it improves outcomes in randomized data.
Study Design
Type
Cohort (n=6,463)
Multicenter
Yes
Structured PICO
Does mild or moderate-to-severe paravalvular regurgitation reduce 4-year survival in patients undergoing TAVR or SAVR for aortic stenosis?
P
Population
6,463 consecutive patients with aortic stenosis who underwent TAVR (n=2,130) or SAVR (n=4,333) with a bioprosthesis from the nationwide FinnValve registry (2008-2017).
I
Intervention
Mild or moderate-to-severe paravalvular regurgitation (PVR) at discharge
C
Comparator
None-to-trace paravalvular regurgitation (PVR)
O
Outcome
4-year mortalityhard clinical
Main Result
Effect estimate: adjusted HR 1.64 (95% CI 1.35-1.99)
Absolute Event Rate: 54.2% vs 69%
Mild and moderate-to-severe paravalvular regurgitation after TAVR are independent predictors of worse mid-term survival, emphasizing the importance of minimizing PVR.
Cite This Study
Laakso et al. (2020) conducted a cohort in aortic stenosis (n=6,463). Paravalvular regurgitation (PVR) vs. None-to-trace PVR was evaluated on 4-year survival after TAVR (mild PVR vs none-to-trace) (adjusted HR 1.64, 95% CI 1.35-1.99). Mild paravalvular regurgitation after TAVR was associated with worse 4-year survival compared to none-to-trace PVR (54.2% vs 69.0%; adjusted HR 1.64, 95% CI 1.35-1.99).