SPC365

Atrioventricular valve regurgitation progression after Transcatheter Aortic Valve Replacement

Session: SESSÃO DE POSTERS 24 - COMPLICAÇÕES NA INTERVENÇÃO VALVULAR AÓRTICA PERCUTÂNEA
Speaker: Miguel Caramelo Abrantes de Figueiredo

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Miguel Abrantes De Figueiredo; Inês Rodrigues; Fernando Ferreira; Francisco Cardoso; Mariana Coelho; Francisco Albuquerque; André Grazina; Tiago Mendonça; António Fiarresga; Rúben Ramos; Rui Cruz Ferreira; Duarte Cacela

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Aortic stenosis is the most frequent heart valve disease requiring intervention in the developed world.</span></span> <span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Transcatheter Aortic Valve Replacement (TAVR) is an excellent treatment modality for patients with high surgical risk or prohibitive surgical anatomy. In this population, the prevalence of multiple valvular heart disease (VHD) is high and the persistence of atrioventricular valve regurgitation (AVVR) post-procedure is associated with higher mortality.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Purpose:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> To evaluate the predictors and the extent of change in AVVR after TAVR in patients with multiple VHD.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">A retrospective analysis of all patients who underwent TAVR until November 2024 in one tertiary care center in Portugal was conducted. VHD was diagnosed and its evolution after TAVR was documented and classified by transthoracic echocardiogram according to the current guidelines. The predictors of AVVR improvement and deterioration were derived with t-test and chi-square analysis, followed by binary logistic regression to determine the independent predictors and their potency.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Of the 831 patients included, mitral regurgitation (MR) had a prevalence of 69.07% and tricuspid regurgitation (TR) of 71.00%. A global reduction in the burden of AVVR was noticed (<strong>FIGURE 1</strong>), with 27.68% of patients experiencing an improvement in MR and 18.77% of patients with reductions in the degree of TR. MR improvement was significantly associated with mildly reduced left ventricular ejection fraction (LVEF) (p=0.024), as well as with a lower body mass index (p=0.021), while higher values of estimated pulmonary artery pressure (ePASP) were the sole independent predictor (OR 1.017 [95% CI: 1.003-1.030], p=0.017) for MR reduction. TR improvement was found in patients with left ventricular disfunction (p=0.001 for LVEF &lt; 50% and p=0.004 for LVEF &lt; 40%), while non-elective TAVR was the sole independent predictor (OR 1.591 [95% CI: 1.008-2.511], p=0.046) for TR reduction. Significant paravalvular leakage was associated with worsening MR (OR 4.196 [95% CI: 1.616-10.891], p=0.003), while chronic kidney disease (OR 2.249 [95% CI: 1.140-4.435], p=0.019) and higher ePASP (OR 1.031 [CI 95% 1.009-1.053], p=0.005) were associated with worsening TR. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> AVVR is prevalent but can be improved after TAVR in patients with multiple VHD. Acknowledging the risk factors for improvement and deterioration of AVVR is important to recognize which patients may be at a greater risk for worse clinical outcomes.</span></span></span></span></p>