Prognostic significance of mild aortic regurgitation in predicting mortality after transcatheter aortic valve replacement Brandon M. Jones, MD, E. Murat.

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Prognostic significance of mild aortic regurgitation in predicting mortality after transcatheter aortic valve replacement Brandon M. Jones, MD, E. Murat Tuzcu, MD, Amar Krishnaswamy, MD, Zoran Popovic, MD, Stephanie Mick, MD, Eric E. Roselli, MD, Sajjad Gul, MD, Jasneet Devgun, BS, Sohi Mistry, Wael A. Jaber, MD, Lars G. Svensson, MD, Samir R. Kapadia, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 3, Pages 783-790 (September 2016) DOI: 10.1016/j.jtcvs.2016.05.023 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Incidence and severity of AR before and after TAVR based on a clinical, echocardiographic grading scheme. TAVR, Transcatheter aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 783-790DOI: (10.1016/j.jtcvs.2016.05.023) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan–Meier estimated mortality at 1 year with varying degrees of AR after TAVR as judged by a clinical echocardiographic grading scheme. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 783-790DOI: (10.1016/j.jtcvs.2016.05.023) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Long-term Kaplan–Meier estimated survival with varying degrees of AR after TAVR as judged by a clinical echocardiographic grading scheme with number of patients at risk at each time interval. AR, Aortic regurgitation. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 783-790DOI: (10.1016/j.jtcvs.2016.05.023) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Long-term Kaplan–Meier survival (A) and 1-year Kaplan–Meier estimated mortality (B) based on a collapsed 3-scale grading scheme for AR after TAVR. Mild includes trivial to 1+, 1+, or 1 to 2+. Moderate includes 2+, 2 to 3+, or 3+. Severe includes 3 to 4+ and 4+. P values based on adjusted HRs comparing groups in the multivariable Cox proportional hazard model. N/A, Not available; TAVR, transcatheter aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 783-790DOI: (10.1016/j.jtcvs.2016.05.023) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Representative, quantitative variables used in the grading of aortic regurgitation after transcatheter aortic valve replacement based on a more granular, clinical grading scale as adapted from American Society of Echocardiography and Valve Academic Research Consortium guidelines. Note that these are not rigid rules but guidelines, and between-grade options are useful for grading cases with discordant data. AR, Aortic regurgitation; n/a, not available; LV, left ventricle. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 783-790DOI: (10.1016/j.jtcvs.2016.05.023) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Mortality at 1 year with varying degrees of AR after TAVR. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 783-790DOI: (10.1016/j.jtcvs.2016.05.023) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Management of acute paravalvular AR after TAVR. This video shows implantation of a #23 Edwards SAPIEN (Edwards Lifesciences, Irvine, Calif) aortic valve in an 88-year-old woman with severe AS. After valve deployment, there is severe AR as seen by transesophageal echocardiogram and by near equalization of the aortic diastolic and left ventricle end-diastolic pressures. Balloon postdilation is completed, and there is only trivial residual paravalvular regurgitation as seen by transesophageal echocardiogram, hemodynamic evaluation, and root aortography. Video available at http://www.jtcvsonline.org/article/S0022-5223(16)30461-5/addons. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 783-790DOI: (10.1016/j.jtcvs.2016.05.023) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions