Impact of mixed aortic valve stenosis on VARC-2 outcomes and postprocedural aortic regurgitation in patients undergoing transcatheter aortic valve implantation: Results from the international multicentric study PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaboration)

Objectives We sought to evaluate the impact of mixed aortic stenosis (MAS) on postprocedural aortic regurgitation (PPAR) and clinical outcomes after transcatheter aortic valve implantation (TAVI). Background The impact of MAS of TAVI outcomes is unknown. Methods and Results Data from a multicenter registry were retrospectively analysed. Outcomes were compared between patients with pure aortic stenosis (PAS; associated AR < 1+/3+) and MAS (associated AR ≥ 1+/3+). Study objectives were PPAR incidence and short- and long-term mortality. Overall, 1,062 patients were included: 419 (39.4%) with MAS and 643 (60.5%) with PAS. At 30 days, there were no differences in mortality, however, a higher incidence of major bleeding (22.7% vs. 16.8%; P = 0.016), PPAR ≥ 1+/3+ (42.6% vs. 26.5%; P < 0.001) and lower device success (89.3% vs. 93.3%; P = 0.019) was observed in patients with MAS. Of note, MAS was an independent predictor of PPAR ≥ 1+/3+ at multivariable analysis (OR: 2.882; CI: 1.851-4.488; P < 0.001). At 2 years of follow-up, no survival differences were present between MAS and PAS groups. Similarly, following stratification for PPAR ≥ 1+/3+, MAS had no protective effect on survival as compared with PAS. Conclusions MAS was associated with lower device success and higher PPAR incidence. However, despite these findings, it had no influence on long-term postoperative outcomes.

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