SPC365

Clinical outcomes of non-severe paravalvular leak after transcatheter aortic valve implantation.

Session: Comunicações Orais - Sessão 03 - Válvula aórtica percutânea
Speaker: Bárbara Lacerda Teixeira

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Bárbara Lacerda Teixeira; Ricardo Carvalheiro; Francisco Barbas Albuquerque; Fernando Ferreira; Miguel Figueiredo; André Grazina; Tiago Mendonça; Inês Rodrigues; António Fiarresga; Ruben Ramos; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">Introduction:</span></span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white"> Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is common and occurs more frequently than surgical aortic valve replacement (SAVR). </span></span></span><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">Previous studies have shown that severe PVL following TAVI is associated with higher 1 year mortality. Nowadays, with the improvements in the new generation valves and increasing operator&rsquo;s experience, severe PVL is rare. However, the presence of mild and moderate PVL remains frequent. Data regarding the impact of non-severe PVL in short-term clinical outcomes is conflicting and in long-term clinical outcomes is scarce. Since TAVI tends to be expanded to a younger population, it is of utmost importance to evaluate the long-term impact of mild and moderate PVL on clinical outcomes. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Objectives:</span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black"> To assess the prevalence of PVL after TAVI in a large cohort and to determine the long-term mortality impact of non-severe PVL.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black">Methods: </span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black">We performed a retrospective analysis in patients (pts) submitted to TAVI in a tertiary center from 2010 to 2022. Pts without echocardiography (TTE) at discharge or with in-hospital mortality were excluded. Pts were divided in two groups according to having any grade of PVL at TTE at discharge. Comparison of groups was made using Chi-square, t-test and Mann-Whitney analysis. Primary endpoint was defined as time to all-cause death over 4 years after TAVI. Kaplan Meier survival curves&nbsp;were used to estimate the risk of events and Cox regression to assess the prognostic relevance of PVL. In pts with assessable TTE at one year, survival analysis was performed again regarding having PVL at one year.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">Results:&nbsp;</span></span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">727 pts (45,8% men, mean age 82) were included. 314 pts (43,2%) had PVL at TTE at discharge: 265 pts (36,5%) mild PVR and 49 pts (6,7%) moderate PVL. No pts showed severe PVL at discharge. Pts with PVL were more likely to be older (p= 0,005), have diabetes (p= 0,005), higher mean aortic valve gradients (p&lt; 0,001) and higher valvular calcium score (p&lt; 0,001). </span></span></span><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">Any grade of PVL was significantly more common in old generation valves than new generation ones (p&lt;0,001), in self-expanding devices than mechanic or balloon expandable (p&lt;0,001), and pre-dilation and post-dilation were more frequently performed (p&lt;0,001). At one year, 25 pts had moderate PVL. </span></span></span><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">Survival analysis revealed that only moderate PVL at 1 year after TAVI had a significantly higher mortality (log-rank p = 0,021), </span></span></span><span style="font-family:Calibri,sans-serif"><span style="color:black">with a HR of 2,26 (95% CI 1,22 &ndash; 4,61 p= 0,025) (Fig 2). Any PVL at discharge and mild PVL at one-year had slightly higher mortality rates, but did not met statistically significance (Fig 3).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">Conclusions:</span></span></span></strong><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white"> With the use of the new-generation valves, the number of pts with PVL has reduced but it&rsquo;s still significant. The presence of any grade of PVL at discharge after TAVI is not associated with differences in all-cause mortality at 4 years, but the pts that maintain moderate PVL at one year have twice the risk of overall mortality in the four years after TAVI.</span></span></span></span></span></span></p>