Author + information
- Received July 14, 2013
- Revision received October 25, 2013
- Accepted November 7, 2013
- Published online March 1, 2014.
- Mohamed Abdel-Wahab, MD∗∗ (, )
- Thomas Comberg, MD†,
- Heinz Joachim Büttner, MD†,
- Mohamed El-Mawardy, MD∗,
- Kenichi Chatani, MD∗,
- Michael Gick, MD†,
- Volker Geist, MD∗,
- Gert Richardt, MD∗,
- Franz-Josef Neumann, MD†,
- Segeberg-Krozingen TAVI Registry
- ∗Cardiology Department, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
- †Cardiology Department, University Heart Center Bad Krozingen, Bad Krozingen, Germany
- ↵∗Reprint requests and correspondence:
Dr. Mohamed Abdel-Wahab, Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel and Hamburg, Am Kurpark 1, 23795 Bad Segeberg, Germany.
Objectives This study sought to assess aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) with the self-expandable Medtronic CoreValve (MCV) (Medtronic Inc., Minneapolis, Minnesota) versus balloon-expandable Edwards Sapien XT valve (ESV) (Edwards Lifesciences, Irvine, California).
Background AR after TAVI has been associated with poor survival, but limited data exist comparing MCV with ESV.
Methods We pooled the prospective TAVI databases of 2 German centers. The primary endpoint was more-than-mild post-TAVI AR assessed by echocardiography. We also assessed device success and survival within 1 year. Endpoints were adjudicated according to the Valve Academic Research Consortium criteria and analyzed by unadjusted and propensity-score–adjusted models.
Results A total of 394 patients were included, 276 treated with MCV and 118 with ESV. More-than-mild AR was significantly higher with MCV than with ESV (12.7% vs. 2.6%, p = 0.002). This difference remained significant after propensity adjustment (adjusted odds ratio [OR]: 4.59, 95% confidence interval [CI]: 1.03 to 20.44). The occurrence of any degree of AR was also higher with MCV (71.6% vs. 56.9%, p = 0.004). Device success was mainly influenced by the occurrence of AR and was consequently higher with ESV (95.8% vs. 86.6%, p = 0.007), but this was not significant after propensity adjustment (adjusted OR: 0.34, 95% CI: 0.11 to 1.03, p = 0.06). At 1 year, survival was comparable between both valve types (83.8% MCV vs. 88.2% ESV, p = 0.42), but was significantly worse in patients with more-than-mild AR (69.8% vs. 87.4%, p = 0.004) and in those with device failure (65.6% vs. 87.4%, p < 0.001).
Conclusions More-than-mild AR after TAVI was more frequent with MCV than with ESV. This finding deserves consideration, as more-than-mild AR was associated with higher mortality at 1 year.
Drs. Abdel-Wahab and Richardt have each received a research grant from Medtronic. Dr. Neumann has reported that his institution has received speakers' honoraria and travel grants from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 14, 2013.
- Revision received October 25, 2013.
- Accepted November 7, 2013.
- American College of Cardiology Foundation