Update on the clinical impact of mild aortic regurgitation after transcatheter aortic valve implantation: Insights from the Japanese multicenter OCEAN‐TAVI registry

摘要

Abstract Objectives This study aimed to compare the clinical impact of mild postprocedural aortic regurgitation (post‐AR) to that of none‐trivial post‐AR after transcatheter aortic valve implantation (TAVI) and to identify the vulnerability factors to mild post‐AR. Background Moderate–severe post‐AR, associated with increased mortality, is an important issue. However, the clinical impact of mild post‐AR remains controversial. Methods and results We analyzed data from 1,572 consecutive patients (1,026 of none‐trivial post‐AR and 546 of mild post‐AR) obtained from the Optimized transCathEter vAlvular Intervention (OCEAN‐TAVI) Japanese multicenter registry. We evaluated the 1‐year cumulative cardiovascular death and re‐hospitalization rates for heart failure (HF) after TAVI according to the degree of post‐AR. Kaplan–Meier curves showed no significant difference between “none‐trivial post‐AR” and “mild post‐AR” in terms of cardiovascular death, but a significant difference was noted in the cumulative incidence of re‐hospitalization for HF between the two groups (hazard ratio 1.57, 95% confidence interval 1.02–2.41, p ?=?.04). In the stratified analysis, only in patients with not more than 50% of left ventricular ejection fraction (LVEF), concentric left ventricular hypertrophy (LVH), and none‐trivial pre‐procedural aortic regurgitation (pre‐AR), mild post‐AR resulted in a higher incidence of re‐hospitalization for HF. Conclusions In this study, the clinical impact of mild post‐AR compared to none‐trivial post‐AR tended to be augmented in the presence of reduced LVEF, concentric LVH, and none‐trivial pre‐AR. Pre‐procedure echocardiographic findings including LVEF, left ventricular geometry, and pre‐AR may help to judge the necessity of postdilatation in case of mild post‐AR just after the bioprosthesis deployment.