• Polykarpos C Patsalis, Thomas F M Konorza, Fadi Al-Rashid, Björn Plicht, Matthias Riebisch, Daniel Wendt, Matthias Thielmann, Heinz Jakob, Holger Eggebrecht, Gerd Heusch, Raimund Erbel, and Philipp Kahlert.
• Department of Cardiology, West German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany. polykarpos-christos.patsalis@uk-essen.de
• EuroIntervention. 2013 Apr 22;8(12):1398-406.

AimsResidual paravalvular aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) is common. We therefore evaluated incidence, determinants and outcome of PAR after TAVI.Methods And ResultsData from 167 consecutive transcatheter TAVI patients were analysed. PAR was graded by angiography and the pressure gradient between diastolic aortic pressure and left ventricular end-diastolic pressure (∆PDAP-LVEDP) after implantation. TAVI was technically successful in all patients. Mortality was 9% and 20% at 30 days and one year, respectively. Post-procedural PAR was absent in 54 patients (32.3%). Mild PAR was found in 89 (53.3%), moderate in 21 (12.6%), and moderate-to-severe in three patients (1.8%). Cardiovascular mortality at 30 days and one year was increased in patients with moderate and moderate-to-severe PAR compared to patients with no and mild PAR (46% vs. 4% and 73% vs. 7%, respectively, p<0.001). Receiver operating characteristic curve analysis suggested ∆PDAP-LVEDP ≤18 mmHg as a novel predictor of mortality, with an area under the curve of 0.97.ConclusionsIn patients undergoing TAVI, moderate and moderate-to-severe PAR was observed in 14.4% and associated with increased cardiovascular mortality. A pressure gradient ∆PDAP-LVEDP≤18 mmHg carries adverse prognosis and requires further intervention.

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