Prognostic predictors after TAVI in patients with severe aortic stenosis and concomitant aortic regurgitation

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Abstract Backgrounds Transcatheter aortic valve implantation (TAVI) has become an established treatment for aortic stenosis (AS). However, in patients with concomitant aortic regurgitation (AR), the hemodynamic changes and clinical outcomes following TAVI may differ from those in patients without AR. The clinical impact of TAVI in this subset of patients remains unclear. Aim This study aimed to identify prognostic predictors following TAVI in patients with severe AS and concomitant AR before the widespread application of TAVI for isolated AR. Methods We analyzed data from a multicenter TAVI registry comprising 4,921 patients who underwent the procedure, focusing on those with severe AS and concomitant moderate or greater AR. The primary endpoint was a composite of all-cause mortality and heart failure-related hospitalization within three years. Results The median age of the study population was 84 years, and 50.1% were female. Among the enrolled patients, 478 (9.7%) had moderate or greater AR. The incidence of the primary endpoint was significantly lower in the moderate or greater AR group compared to the mild or less AR group (17.6% vs. 23.4%, p = 0.037) (Figure 1). Cox regression analysis found no significant associations between the primary endpoint and age, sex, body mass index (BMI), or body surface area (BSA) (p > 0.05). However, multivariate analysis identified diabetes (HR 2.32, 95% CI 1.08–4.96), estimated glomerular filtration rate (eGFR) per 1-unit increase (HR 0.97, 95% CI 0.95–0.99), and serum albumin per 1-unit increase (HR 0.19, 95% CI 0.09–0.39) as independent predictors of long-term outcomes. No significant associations were observed between the primary endpoint and computed tomography (CT) findings or post-procedural echocardiographic parameters, including left ventricular ejection fraction (LVEF), mean pressure gradient, or paravalvular leakage (p > 0.05). In patients with LVEF < 50%, post-TAVI improvements were noted in both end-diastolic diameter [from 53 mm (47–57) to 48 mm (32–45)] and ejection fraction [from 40% (44–53) to 45% (36–56)] (Figure 2). Conclusions Patients with AS and concomitant moderate or greater AR demonstrated better post-TAVI outcomes compared to those with mild or less AR, suggesting that this subgroup may derive greater benefit from TAVI. Furthermore, in patients with severe AS and concomitant moderate or greater AR, traditional clinical markers—such as diabetes, renal function, and serum albumin levels—were independent predictors of long-term outcomes, rather than post-procedural hemodynamic parameters.

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