THE REVERSIBILITY OF CARDIAC DAMAGE AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION AND SHORT-TERM OUTCOMES

Background: Aortic stenosis (AS) is the most common valvular disease in aging population and causes extra-valvular cardiac damages along with valve deterioration. Recently, the staging based on extent of damage was proposed and its reversibility after transcatheter aortic valve implantation (TAVI) was studied. Accordingly, we pursued to explore cardiac damage using this staging and to propose a short-term prognosis in real-world population.
Methods: Patients with severe AS who underwent TAVI were retrospectively analyzed. Patients were classified into five stages based on the presence and extent of cardiac damage by echocardiographic measurements at baseline and 6-month after TAVI. Clinical endpoint was all-cause mortality.
Results: 734 patients with severe AS (mean age 79.8 ± 7.4 years, 54.5% male) were included. Thirty-five (4.8%) patients did not have any cardiac damage (stage 0), 84 (11.4%) patients had LV damage (stage 1), 210 (28.6%) patients had left atrial and/or mitral valve damage (stage 2), 223 (30.4%) patients had pulmonary vasculature and/or tricuspid valve damage (stage 3) and 182 (24.8%) patients had right ventricular damage. Kaplan-Meier survival curves before and after TAVI were both significant (Figure 1). On multivariable analysis, cardiac damage was significantly associated with all-cause mortality. At 6-month after TAVI, 40.7% of patients improved at least 1 stage, 36.1% patients stabilized in the same stage and 13.4% showed worsening of at least 1 stage.
Conclusions: The proposed staging is crucial for the optimal timing for valve replacement and demonstrates the impact of TAVI could bring improvement except for patients at stage 4.