Five-year evolution of mild aortic regurgitation following transcatheter aortic valve implantation: early insights from a single-centre experience

OBJECTIVES: To assess the follow-up evolution and impact of mild aortic regurgitation (1 + AR) following transcatheter aortic valve implantation (TAVI). METHODS: We evaluated the follow-up outcomes and AR evolution of 558 patients affected by native aortic stenosis who underwent TAVI with residual AR <= 1+. RESULTS: No residual AR was found in 294 (52.7%) patients, whereas 1 + AR was found in 264 (47.3%) patients. At 5.5 years, freedom from all-cause mortality (56.9% vs 53.5%), cardiac mortality (75.0% vs 74.3%) and heart failure (70.0% vs 63.9%) were similar between no-AR and 1 + AR groups, respectively (all P > 0.05). New York Heart Association Class I-II was found in 88.9% vs 82.4% of patients respectively (P= 0.013). Freedom from AR >= 3+ at 5.5 years was 98.6% in the no-AR group vs 82.5% in the 1 + AR group (log-rank <0.001). Residual 1 + AR was found to be an independent predictor of increased follow-up AR >= 3+ (P = 0.012). In 1 + AR group, higher left ventricle mass index independently predicted increased cardiac death [ hazards ratio (HR) 1.01, confidence interval (CI) 1.00-1.02, P = 0.036] and heart failure rate (HR 1.01, CI 1.00-1.02, P = 0.002), while larger native aortic annulus perimeter predicted follow-up AR >= 3+ (HR 1.12, CI 1.02-1.22, P = 0.016). CONCLUSIONS: 5 years after TAVI, a higher progression of paravalvular AR to Grade >= 3+ together with worse symptoms were found in patients with residual 1 + AR compared with no-AR, although no marked difference in survival was observed. These findings raise further concerns about 1+ residual AR after TAVI, especially in the perspective of expanding indications to younger low-risk patients. Mechanisms that cause progression of paravalvular AR after TAVI remain to be clarified.