Key result
ARI ratio < 0.6 predicts ~96% higher 1-year mortality after TAVI with self-expanding devices.
Why the study?
Grading paravalvular leak during TAVI is challenging, prompting evaluation of whether per-procedural invasive hemodynamic measures could optimize grading and predict outcomes with self-expanding devices.
Does the aortic regurgitation index (ARI) ratio predict 1-year mortality in patients undergoing TAVI with self-expanding devices?
Cohort (n=651)
Does the aortic regurgitation index (ARI) ratio predict 1-year mortality in patients undergoing TAVI with self-expanding devices?
An ARI ratio < 0.6 during TAVI with self-expanding devices is a strong independent predictor of 1-year mortality, highlighting its potential utility in procedural decision-making for paravalvular leak.
Answers are grounded in this paper and cite their sources.
May flag higher-risk self-expanding TAVI cases; leaves open whether ARI-guided management improves survival.
Grading paravalvular leak (PVL) at the time of transcatheter aortic valve implantation (TAVI) deployment is challenging. Per-procedural invasive hemodynamic measurements could serve to optimize PVL grading and predict outcome after TAVI. The aim of this study was to compare hemodynamic measures of paravalvular leak and their prognostic relevance in self-expanding TAVI devices. Between December 2008 and December 2017 consecutive patients treated for severe symptomatic aortic valve stenosis with self-expanding devices were prospectively studied. Peri-procedural hemodynamic measurements, echocardiographic data as well as clinical follow-up according to VARC-2 criteria were prospectively collected. Diastolic delta (DD), heart rate adjusted DD, aortic regurgitation index (ARI) and ARI ratio were calculated and assessed for their association with 1-year mortality. A total of 651 patients were studied. Moderate or severe paravalvular leakage was found in 4.8% of patients. ARI ratio < 0.6 (hazard ratio 1.96 [1.23-3.12], P = 0.005) was the best independent predictor of 1-year mortality. This study confirms the value of hemodynamic measures, specifically ARI ratio, for prognostication, potentially supporting procedural decision-making with regard to PVL.
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Wely et al. (2020) conducted a cohort in Severe symptomatic aortic valve stenosis (n=651). Aortic regurgitation index (ARI) ratio < 0.6 was evaluated on 1-year mortality (HR 1.96, 95% CI 1.23-3.12, p=0.005). An aortic regurgitation index (ARI) ratio < 0.6 was a strong independent predictor of 1-year mortality after TAVI with self-expanding devices.
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