German TAVI Registry Analysis Identifies Predictors of 1-Year Mortality

August 6, 2014—An evaluation of the predictors of 1-year mortality in patients with aortic regurgitation after transcatheter aortic valve implantation (TAVI) in the multicenter German TAVI registry was published by Mohamed Abdel-Wahab, MD, et al in Heart  (2014;100:1250-1256).

According to the investigators, residual aortic regurgitation (AR) after TAVI has been associated with increased mortality. Nevertheless, a considerable proportion of these patients survives and appears to tolerate AR. Identification of patients at higher risk of death may assist in tailoring therapy, but predictors of mortality in this subset of patients are largely unknown.

As summarized in Heart, a total of 1,432 patients were included in the German TAVI registry. One-year follow-up data were available for 1,318 patients (92%). Of the latter, 201 patients (15.2%) had more-than-mild AR, as evaluated by angiography, and represent the population of the current analysis. Among these patients, baseline demographic, clinical, echocardiographic, and angiographic characteristics were compared among survivors and nonsurvivors to identify factors associated with mortality at 1 year.

In the analysis, the mean age was 81.2 ± 6.6 years, and men represented 55% of patients. The mean logistic EuroSCORE was 22 ± 15%. Overall, 92% of patients received the Medtronic CoreValve, and 8% received the Edwards Sapien valve.

The investigators reported that at 1 year, 61 patients (31%) with more-than-mild post-TAVI AR had died. Compared with patients who survived, patients who died more commonly had coronary artery disease, peripheral arterial disease, and chronic renal impairment. Patients who died had a lower baseline left ventricular ejection fraction (44 ± 18% vs 52 ± 16%; P = .002), higher prevalence of more-than-mild (≥2+) mitral regurgitation (44% vs 27%; P = .001), and a higher systolic pulmonary artery pressure (51 ± 18 mm Hg vs 44 ± 19 mm Hg; P = .002), but the severity of aortic stenosis was similar, and the prevalence and severity of pre-TAVI AR was comparable (any AR in 88% vs 83%, respectively; P = .29). Using Cox regression analysis, only baseline mitral regurgitation ≥ 2+ (hazard ratio [HR], 1.77; 95% CI, 1.05–2.99; P = .03) and systolic pulmonary artery pressure (HR, 1.15; 95% CI, 1.01 to 1.33; P = .04) were independently associated with 1-year mortality, while female sex was protective (HR, 0.54; 95%, CI 0.3 to 0.96; P = .03).

The evaluation identified preprocedural characteristics associated with 1-year mortality in patients with more-than-mild AR after TAVI. More-than-mild baseline mitral regurgitation, higher systolic pulmonary artery pressure, and male sex were independently associated with worse outcome, concluded the investigators in Heart.