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Comparative survival and role of STS score in aortic paravalvular leak after SAVR or TAVR: a retrospective study from the USA
  1. Ratnasari Padang1,
  2. Mahmoud Ali1,
  3. Kevin L Greason2,
  4. Christopher G Scott3,
  5. Manasawee Indrabhinduwat1,
  6. Charanjit S Rihal1,
  7. Mackram F Eleid1,
  8. Vuyisile T Nkomo1,
  9. Patricia A Pellikka1,
  10. Sorin V Pislaru1
  1. 1 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Sorin V Pislaru; pislaru.sorin{at}mayo.edu

Abstract

Objective The presence of aortic paravalvular leak (PVL) is associated with lower survival, but a direct comparison of its impact after transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) has not been performed. This study sought to determine the differential influence of PVL on survival following TAVR versus SAVR and in patients with varying levels of risk as defined by the Society of Thoracic Surgeons (STS) risk score.

Methods Patients with and without postprocedural PVL were identified from 2290 patients undergoing TAVR or SAVR at Mayo Clinic between 2008 and 2014. The primary endpoint was overall survival.

Results There were 588 patients with PVL (374 TAVR, 214 SAVR): age 78±11 years, 63% male and mean follow-up of 3±2 years. PVL was trivial/mild in 442 (75%) patients. In propensity-matched analyses (n=86 per group), the overall survival at 1 and 4 years was 93% and 56% vs 89% and 61% in patients with PVL after TAVR versus SAVR, respectively (p=0.43). The presence or degree of PVL severity had no influence on survival of patients with high STS score (≥8%), while the presence of greater than mild PVL predicted worse survival in those with STS score <8%. During the first year after PVL diagnosis, while either improvement or stable PVL grade was seen in the majority of patients, worsening of PVL grade was more common in the TAVR group (19%) versus the SAVR group (4%) (p<0.0001).

Conclusions At mid-term follow-up, the presence of PVL was associated with equally unfavourable outcomes following SAVR or TAVR. In patients with high STS risk score, the presence of PVL was not independently associated with increased mortality.

  • echocardiography
  • valvular heart disease
  • cardiac surgery
  • adult cardiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors RP and MA were responsible for the design, data collection, analysis, interpretation of data, and drafting and revising the manuscript. CS was responsible for data and statistical analysis. KG, CSR, ME, VN and PAP were responsible for critical revision of the manuscript for important intellectual content, and MI for critical data collection and analysis during manuscript revision. SP was responsible for the design, interpretation of data, critical revision of the manuscript and final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Mayo Clinic Institutional Review Board Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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