Severe aortic stenosis (AS) with concomitant aortic insufficiency (AI) among patients undergoing TAVR is associated with lower mortality and heart failure (HF) hospitalization after one year, according to a study published July 17 in the American Heart Journal.

Bhaskar Bhardwaj, MD, et al., used data from the STS/ACC TVT Registry to analyze prevalence of severe AS with concomitant AI among patients undergoing TAVR and look at TAVR outcomes in this population. The researchers identified 54,535 patients with severe AS with or without concomitant AI who underwent TAVR at 442 sites between 2011 and 2016. Patients were categorized into four groups based on the severity of AI at baseline: isolated severe AS, severe AS with trace or mild AI, severe AS with moderate AI, and severe AS with severe AI. The study's primary endpoints were one-year rates of all-cause mortality and HF hospitalization. The researchers linked registry data with claims data from the Center for Medicare and Medicaid Services (CMS) to assess one-year outcomes. Secondary endpoints included device success, residual AI and in-hospital major vascular complications.

In the total study population of 54,535 patients, 21.9% (11,967) had isolated AS, 59.0% (32,153) had AS with mild AI, 16.4% (8,933) had AS with moderate AI, and 2.7% (1,482) had AS with severe AI. Patients with moderate or severe AI at baseline had higher STS risk scores, greater left ventricular internal diastolic dimensions, higher right ventricular systolic pressures, more aortic annular calcification, and lower ejection fractions, when compared with patients with AS and no AI or mild AI.

Linked CMS data were available for 63.6% of patients (34,678). The risk of mortality and HF hospitalization decreased with increasing severity of pre-TAVR AI. Mortality decreased by 6% for every one grade increase in preprocedure AI (hazard ratio [HR], 0.94 per 1 grade increase in AI severity; 95% confidence interval [CI], 0.91-0.98; p<0.001). For HF hospitalization, each one grade increase in preprocedure AI was associated with a 13% decrease in HF hospitalization (HR, 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, p<0.001). In terms of secondary outcomes, patients with more severe baseline AI had lower device success and were more likely to have residual AI. There were no differences for in-hospital major vascular complications based on AI severity.

According to the researchers, baseline AI was associated with lower procedural success but lower rates of mortality and HF hospitalization after one year. Additional research with baseline and follow-up echocardiographic data is needed to better understand why patients with baseline AI in patients have lower mortality and HF hospitalization, they conclude.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound

Keywords: Transcatheter Aortic Valve Replacement, Centers for Medicare and Medicaid Services, U.S., Stroke Volume, Medicaid, Medicare, Aortic Valve Insufficiency, Aortic Valve Stenosis, Echocardiography, Diastole, Heart Failure, Registries, Hospitalization, National Cardiovascular Data Registries, STS/ACC TVT Registry

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