Prognostic significance of mild aortic regurgitation in predicting mortality after transcatheter aortic valve replacement

This article investigates the effects of varying degrees of aortic regurgitation (AR) on survival after transcatheter aortic valve replacement (TAVR).  They retrospectively evaluated a cohort of 237 patients undergoing TAVR from 2006 to 2012 with echocardiogram performed within 30 days of the procedure.  Using a Cox proportional multivariable regression model, they found each 1+ increase in AR (on a scale of none to 4+) was associated with a unit hazard ratio of 2.26.   After TAVR, patients with no paravalvular aortic regurgitation (15% of patients) had 0% mortality at 1 year, trivial to 1+ AR (29.5% of patiens) had 7.1% mortality at 1 year, and 1+ AR (32.5% of patients) had 16.9% mortality at 1 year.   The authors conclude that even a mild degree of AR is associated with significant prognostic value after TAVR and that more discriminating grading scales of AR will be important in evaluating TAVR as it is applied to intermediate and low risk patient populations.