Al Lawati, Hatim

Amat-Santos, Ignacio J.

Barbanti, Marco

Benitez, Luis M.

Bergeron, Sébastien

Briales, Juan Alonso

Cheema, Asim

Cucalon, Angela Maria

Dager, Antonio E.

Dumont, Eric

Garcia del Blanco, Bruno

Immè, Sebastiano

Jerez-Valero, Miguel

John, Webb

Munoz-Garcia, Antonio J.

Nombela-Franco, Luis

Pibarot, Philippe

Revilla, Ana

Ribeiro, Henrique B.

Rodes-Cabau, Josep

Serra, Vicenç

Tamburino, Corrado

Urena, Marina

Elsevier - Publisher Connector 

Table. Baseline characteristics and clinical outcomes of patients that
underwent TAVR
Underweight
(n¼109)
Normal
weight
(n¼1,029)
Overweight
(n¼800)
Obese
(n¼484)
Morbidly
obese
(n¼97) p-value
Age (yrs) 85.9  6.3 86.5  6 84.9  6.4 80.7  8 76.8  7.8 <0.001
STS score
(%)
12.9  3.9 11.9  4.5 11.1  3.6 10.8  3.7 10.8  3.9 <0.001
6-minute
walk test
(m)
96  103 116  117 110  117 86  103 58  89 <0.001
30-day
mortality
9.2% 7.7% 4.6% 4.1% 9.3% 0.007
1-year
mortality
33.2% 25.6% 21% 17.1% 17.6% <0.001
www.jacctctabstracts2014com SATURDAY, SEPTEMBER 13, 2014, 5:00 PM–7:00 PMTCT-691
Clinical Impact of the Presence of Aortic Regurgitation Following
Transcatheter Aortic Valve Replacement:Insights into the Degree and
Acuteness of Presentation
Marina Urena1, Miguel Jerez-Valero2, Webb John3, Corrado Tamburino4,
Antonio J. Munoz-Garcia5, Asim Cheema6, Antonio E. Dager7, Vicenç Serra8,
Ignacio J. Amat-Santos9, Marco Barbanti10, Sebastiano Immè11,
Juan Alonso Briales12, Hatim Al Lawati13, Luis M. Benitez14,
Angela Maria Cucalon15, Bruno Garcia del Blanco16, Ana Revilla17, Eric Dumont18,
Henrique B. Ribeiro19, Luis Nombela-Franco20, Sébastien Bergeron21,
Philippe Pibarot22, Josep Rodes-Cabau23
1Quebec Lung and Heart Institute, Laval University, Québec, Canada, 2Quebec Lung
and Heart Institute, Laval University, Québec, Quebec, 3St Pauls Hospital,
Vancouver, British Columbia, 4University of Catania, Catania, Italy, 5Hospital
Clínico de Málaga, Universidad de Malaga, Malaga, Andalusy, 6St. Michael’s
Hospital, Toronto, Canada, 7Angiografía de Occidente, SA, Cali, colombia, 8Vall
d’Hebron University Hospital, Barcelona, Spain, Barcelona, Cataluña, 9Quebec
Heart and Lung Institute, Quebec, Canada, Quebec, Quebec, 10Ferrarotto Hospital,
University of Catania, Catania, Italy, 11FERRAROTTO’S HOSPITAL, Catania,
Catania, Italy, 12Hospital Virgen de la Victoria, Malaga, Spain, 135St-Michael’s
hospital, Toronto University, Toronto, Ontario, Canada, Toronto, Ontario,
14Angiograﬁa de Occidente S.A, Cali, Cali, 15Clìnica de Occidente de Cali, Colombia,
Cali, Colombia, 16Vall d’Hebron University Hospital, Barcelona, Spain, Barcelona,
Spain, 17Hospital Clinico Universitario de Valladolid, Valladolid, Spain, Valladolid,
Castilla y Leon, 18Quebec Heart and Lung Institute, Laval University, Quebec, QC,
19Quebec Heart and Lung Institute, Laval University, Quebec City, Canada,
20Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Madrid, 21Quebec
Heart & Lung Institute, Laval University, Québec, Québec, 22N/A, Quebec City,
Canada, 23Quebec Heart and Lung Institute, Quebec, Canada
Background: The objectives of this study were to determine the impact of the degree
of residual aortic regurgitation (AR) and acuteness of presentation of AR following
transcatheter aortic valve replacement (TAVR) on outcomes.
Methods: A total of 1735 patients undergoing TAVR with balloon- or self-expanding
valves were included. The presence and the degree of AR were evaluated by trans-
thoracic echocardiography; acute AR was deﬁned as an increase in AR severity of
1 degree compared to pre-procedural echocardiography.
Results: Residual AR was classiﬁed as mild in 761 (43.9%) patients and moderate-
severe in 247 (14.2%) patients. The presence of moderate-severe AR was an inde-
pendent predictor of mortality at a mean follow-up of 2117 months when compared
to none-trace (adjusted HR [95%CI]: 1.88 [1.37-2.58], p < 0.001) and mild AR
(adjusted HR [95%CI]: 1.69 [1.27-2.25], p< 0.001) groups. There was no increased
risk in patients with mild AR compared to those with none-trace AR (p¼0.393). In
patients with moderate-severe AR, acute AR was observed in 161 (65%) patients and
chronic AR in 86 (35%) patients. Acute moderate-severe AR was independently
associated with increased risk of mortality when compared to none-trace-mild AR
(adjusted HR [95%CI]: 2.37 [1.53-3.66], p< 0.001) and chronic moderate-severe AR
(adjusted HR [95%CI]: 2.24 [1.17-4.30], p¼0.015). No differences in survival rate
were observed between patients with chronic moderate-severe and none-trace-mild
AR (p>0.50).
Conclusions: In conclusion, residual AR is a frequent complication of TAVR. The
clinical impact (increased acute and late overall and cardiovascular mortality) of this
complication was mainly limited to those patients with moderate-severe AR of acute
origin (signiﬁcant increase vs. baseline), suggesting that early additional measures for
the treatment of paravalvular leaks leading to a decrease in the severity of AR in such
patients are probably of major clinical importance. The ﬁnal risk/beneﬁt ratio of such a
strategy will have to be determined in future studies.
TCT-692
Multicentre clinical study evaluating a novel resheatable self-expanding
transcatheter aortic valve system
Ganesh Manoharan1, Axel Linke2, Helge Moellmann3, Martyn Thomas4,
Ulrich Schäfer5, Karl-Heinz Kuck6, Stephen G. Worthley7, Alexander Lauten8,
Gerhard Schymik9, A. J. van Boven10, Christian Butter11, Lars Sondergaard12,
Thomas Walther13
1Royal Victoria Hospital, Belfast, Belfast, United Kingdom, 2University of Leipzig,
Heart Center, Leipzig, Germany, 3Kerckhoff Heart Center, Bad Nauheim, Germany,
4St Thomas’ Hospital, London, United Kingdom, 5Department of Cardiology,
Asklepios Klinik St. Georg, Hamburg, Germany, Hamburg, Germany, 6Cardiology,
Hamburg, Germany, 7The University of Adelaide, Adelaide, Australia, 8University
Hospital Jena, Jena, Germany, 9Municipal Hospital Karlsruhe, Karlsruhe, Germany,
10Medisch Centrum Leeuwarden, Leeuwarden, Netherlands, 11Herzzentrum
Brandenburg, Bernau, Germany, 12MDSc, Copenhagen, Denmark, 13Kerckhhoff
Heart Center, Bad Nauheim, Germany
Background: Transcutaneous aortic valve replacement(TAVR) signiﬁcantly im-
proves the prognosis of patients; however limitations with repositioning and optimi-
zation of placement can result in complications. This investigation evaluates theJACC Vol 64/11/Suppl B j September 13–17, 2014 j TCT Abstracts/Varesheathable and repositionable St Jude Medical Portico self-expanding TAVR
system.
Methods: This prospective, single arm, multicenter study evaluated the safety and
efﬁcacy of the Portico System. Between March 2012 and April 2014, 120 TAVR
patients were enrolled and treated at 10 sites in the UK, Germany, Netherlands and
Australia using the 18F and 19F Portico system (23mm, 25mm, 27mm or 29mm
valve). Patients were followed post procedure at 30, 90, 180 days and 1 year. Adverse
events were categorized by VARC deﬁnitions and adjudicated by an independent
events committee. Echocardiography was evaluated by an independent laboratory.
Results: The Portico TAVR system was successfully implanted in 118 patients
(94% Female; Mean Age¼84; STS¼6.0). Resheathing (27%) was successful in all
instances. Paravalvular Leak at 30 days (n¼59), as assessed by core lab 15.3 absent/
trace, 72.9% mild, 3.4% moderate and 0% severe. Average implant depth was 7.8mm
(n¼89). There was signiﬁcant HF improvement over time with no remaining Class IV
HF patients at 3 months, and 80% of patients achieving Class I or II status at 1 year.
Hemodynamic performance signiﬁcantly improved post TAVI and maintained at
follow-ups. Mean Aortic Valve Area improved from 0.6 cm2 to 1.7, 1.6, 1.5 and 1.5
cm2 at 30 days, 3, 6 and 12 months, respectively. Mean gradient improved from 45.8
mmHg, to 8.7, 9.2, 9.5, 9.9 mmHg over the same follow-up intervals. Mortality at
30 days was 3.0%, all due to cardiovascular causes. Mortality increased to 8.0%
through all follow-up, with 5.0% due to cardiovascular causes. Disabling stroke was
observed in 3.0% of patients through 30 days, and 3.3% through follow-up. Eleven
patients (9.2%) had new pacemaker implantation.
Conclusions: The novel Portico TAVR system allows for safe repositioning and
optimization of the device position. The functional and symptomatic outcomes appear
to support the efﬁcacy and safety of the device.
TCT-693
Inﬂuence of Body-Mass-Index on Survival of Aortic Stenosis Patients Treated
by Transcatheter Aortic Valve Replacement: Insights on Obesity-Paradox
from The PARTNER Trial
Danny Dvir1, Jonathon A. Leipsic2, Dion Stub3, David A. Wood4, Ke Xu5,
Sandra Lauck6, Rakesh M. Suri7, Augusto Pichard8, Philippe Genereux9,
Vinod Thourani10, Martin Leon11, Webb John12
1St Paul’s Hospital, Vancouver, Canada, Vancouver, Canada, 2St. Paul’s Hospital,
Vancouver, Canada, 3Baker IDI Heart and Diabetes Institute, Melbourne, Australia,
4University of British Columbia, Vancouver, Canada, 5Cardiovascular Research
Foundation, New York, NY, 6University of British Columbia, Vancouver, BC, 7Mayo
Clinic, Rochester, MN, 8washsington hospital center, Washington, United States,
9Columbia University Medical Center, New York, 10Emory University, Atlanta, United
States, 11Cardiovascular Research Foundation, New York, United States, 12St Pauls
Hospital, Vancouver, British Columbia
Background: We sought to evaluate possible inﬂuence of body mass index (BMI) on
survival of patients with severe aortic stenosis (AS) in different treatment strategies.
Methods: Patients who underwent transcatheter aortic valve replacement (TAVR) in
the PARTNER trial were evaluated according to their BMI (n¼2,519): underweight
(< 18.5 kg/m2, n¼109), normal weight (18.5-25 kg/m2, n¼1,029), overweight (25-30
kg/m2, n¼800), obese (30-40 kg/m2, n¼484), and morbidly obese (40 kg/m2,
n¼97).
Results: In the total group of patients that underwent TAVR: obese patients were
younger, had lower STS score and worse 6-minute walk performance at baseline
(table). Patients that were underweight and those with morbid obesity had the highest
30-day mortality. After propensity matching, adjusting for dissimilarity between the
normal weight, overweight and obese groups, obese patients had lower 1-year mor-
tality than patients with normal body weight (18.7% vs. 29.4%, p¼0.002). Multi-
variate analysis revealed that obesity was a strong independent predictor for 1-year
survival after TAVR: obesity vs. normal weight, odds ratio 1.37 (CI, 1.05-1.78,
p¼0.02); obesity vs. underweight, odds ratio 2.13 (CI 1.4-3.22, p< 0.001).
Conclusions: In patients with severe AS undergoing TAVR, those having obesity had
better survival than those with normal body weight, after adjustment for differences in
baseline characteristics. The “obesity-paradox” was evident in high-risk AS patients.lvular disease - Aortic: TAVR B203


TCT-691 Clinical Impact of the Presence of Aortic Regurgitation Following Transcatheter Aortic Valve Replacement:Insights into the Degree and Acuteness of Presentation 

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TCT-691 Clinical Impact of the Presence of Aortic Regurgitation Following Transcatheter Aortic Valve Replacement:Insights into the Degree and Acuteness of Presentation

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