Aortic regurgitation after transcatheter aortic valve implantation: are all patients equally affected?

Background: Aortic regurgitation (AR) is an important complication of transcatheter aortic valve implantation (TAVI) and even moderate AR is associated with increased mid-term mortality after TAVI. This association with decreased survival is poorly explained. We sought to analyse the impact of AR on mortality after TAVI as a function of baseline NT-proBNP (NTBNP). Methods: We included 246 consecutive patients from our single centre registry, all implanted with the Edwards valve, via the transfemoral route. AR severity was evaluated by transthoracic echocardiography. NTBNP was measured 24 hours before implantation and patients were divided in 2 groups according to the median NTBNP value. Results: Mean age was 83.6±7 years and 142 (58%) were women. Median NTBNP value was 2057 pg/ml. Patients with low NTBNP had higher left ventricular ejection fraction: 60±14% vs. 49±19%, p<0.001, smaller telediastolic: 52 mm (47–57) vs. 56 mm (49–61), p=0.007 and telesystolic diameters: 33 mm (28–37) vs. 38 mm (32–47), p<0.001, but a similar mean aortic gradient: 46±15 mmHg vs. 46±19 mmHg, p=0.97. Baseline AR ≥ 2 was less frequent in the low NTBNP group: 25% vs. 43%, p=0.005. After TAVI, AR ≥2 occurred in 27% and was significantly associated with increased 1-year (p=0.001) and 2-year mortality (p<0.001) only in the low NTBNP group (Figure). ![Figure][1] Survival at 2 years after TAVI Conclusion: More than mild AR after TAVI was associated with increased 2-year mortality only in patients with low baseline NTBNP. Our data suggest that the impact of AR after TAVI is absent in patients with remodelled ventricles and more severe baseline AR. [1]: pending:yes