Effect of Baseline Aortic Regurgitation on Mortality in Patients Treated With Transcatheter or Surgical Aortic Valve Replacement (from the CoreValve US Pivotal Trial)

Paul A. Grayburn, Jae Kuen Oh, Michael J. Reardon, Jeffrey J. Popma, G. Michael Deeb, Mike Boulware, Jian Huang, Robert C. Stoler

Research output: Contribution to journalArticle

Abstract

This study was performed to determine if baseline aortic regurgitation (AR) affects the deleterious effects of postprocedure paravalvular leak following transcatheter aortic valve implantation (TAVI). We evaluated the effect of baseline AR on mortality in a large cohort of patients randomized to transcatheter or surgical aortic valve replacement (SAVR). The analysis cohort comprised 739 patients who underwent attempted TAVI (n = 386) or SAVR (n = 353) in the CoreValve US Pivotal High Risk Trial and had baseline AR measurements. Patients were stratified by the severity of baseline AR into those with none and/or trace and those with ≥mild AR. Echocardiographic measurements were assessed by an independent core laboratory. Of the 386 TAVI patients, 204 (52.9%) had none and/or trace at baseline AR; 182 (47.2%) had ≥mild AR. Of the 353 SAVR patients, 169 (47.9%) had none and/or trace and 184 (52.1%) ≥mild AR. The presence of ≥mild baseline AR was associated with lower all-cause mortality at 1 year following TAVI (9.4% vs 18.6%, p = 0.008) or SAVR (13.3% vs 24.4%, p = 0.009). Mortality remained lower in the ≥mild baseline AR patients at 3 years after SAVR (p = 0.011), but not TAVI. In conclusion, baseline AR appears to provide a protective effect on survival and quality of life in both TAVI and SAVR patients at 1 year; this effect persists out to 3 years in SAVR patients.

Original languageEnglish (US)
Pages (from-to)1527-1535
Number of pages9
JournalAmerican Journal of Cardiology
Volume122
Issue number9
DOIs
StatePublished - Nov 1 2018

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Aortic Valve Insufficiency
Aortic Valve
Surgical Instruments
Mortality
Transcatheter Aortic Valve Replacement
Cohort Studies
Quality of Life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Effect of Baseline Aortic Regurgitation on Mortality in Patients Treated With Transcatheter or Surgical Aortic Valve Replacement (from the CoreValve US Pivotal Trial). / Grayburn, Paul A.; Oh, Jae Kuen; Reardon, Michael J.; Popma, Jeffrey J.; Deeb, G. Michael; Boulware, Mike; Huang, Jian; Stoler, Robert C.

In: American Journal of Cardiology, Vol. 122, No. 9, 01.11.2018, p. 1527-1535.

Research output: Contribution to journalArticle

Grayburn, Paul A. ; Oh, Jae Kuen ; Reardon, Michael J. ; Popma, Jeffrey J. ; Deeb, G. Michael ; Boulware, Mike ; Huang, Jian ; Stoler, Robert C. / Effect of Baseline Aortic Regurgitation on Mortality in Patients Treated With Transcatheter or Surgical Aortic Valve Replacement (from the CoreValve US Pivotal Trial). In: American Journal of Cardiology. 2018 ; Vol. 122, No. 9. pp. 1527-1535.
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abstract = "This study was performed to determine if baseline aortic regurgitation (AR) affects the deleterious effects of postprocedure paravalvular leak following transcatheter aortic valve implantation (TAVI). We evaluated the effect of baseline AR on mortality in a large cohort of patients randomized to transcatheter or surgical aortic valve replacement (SAVR). The analysis cohort comprised 739 patients who underwent attempted TAVI (n = 386) or SAVR (n = 353) in the CoreValve US Pivotal High Risk Trial and had baseline AR measurements. Patients were stratified by the severity of baseline AR into those with none and/or trace and those with ≥mild AR. Echocardiographic measurements were assessed by an independent core laboratory. Of the 386 TAVI patients, 204 (52.9{\%}) had none and/or trace at baseline AR; 182 (47.2{\%}) had ≥mild AR. Of the 353 SAVR patients, 169 (47.9{\%}) had none and/or trace and 184 (52.1{\%}) ≥mild AR. The presence of ≥mild baseline AR was associated with lower all-cause mortality at 1 year following TAVI (9.4{\%} vs 18.6{\%}, p = 0.008) or SAVR (13.3{\%} vs 24.4{\%}, p = 0.009). Mortality remained lower in the ≥mild baseline AR patients at 3 years after SAVR (p = 0.011), but not TAVI. In conclusion, baseline AR appears to provide a protective effect on survival and quality of life in both TAVI and SAVR patients at 1 year; this effect persists out to 3 years in SAVR patients.",
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AU - Oh, Jae Kuen

AU - Reardon, Michael J.

AU - Popma, Jeffrey J.

AU - Deeb, G. Michael

AU - Boulware, Mike

AU - Huang, Jian

AU - Stoler, Robert C.

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