Impact of previous acute pulmonary oedema after transcatheter aortic valve implantation: Insight from French Aortic National CoreValve and Edwards 2 [FRANCE 2]registry

- Patients were divided into 3 groups according to the frequency of acute PO episode.
- No-PO was observed in 1880, a single-PO in 937, and multiple-PO in 378 patients.
- One-year mortality increased significantly across the groups with at least one PO.
- Single-PO was not independently associated with an increased mortality after TAVI.
- Multiple-PO was an independent predictor of higher mortality after TAVI.

BackgroundThe prognostic value of previous pulmonary oedema (PO) has not been thoroughly investigated in a large-cohort of TAVI-patients. The aim of this study was to assess the influence of previous clinical history of acute PO in severe aortic stenosis (AS) patients undergoing transcatheter aortic valve implantation (TAVI).MethodsData were analyzed for 3195 patients enrolled in the French national TAVI registry, FRANCE 2. We compared the clinical outcome of enrolled patients divided broadly into three groups according to the frequency of previous acute PO episode; group 1: no-episode, group 2: single-episode, and group 3: multiple-episodes within the year preceding TAVI.ResultsOf the 3195 patients (mean age: 82.7 ± 7.2 years, mean logistic-EuroSCORE: 21.8 ± 14.3) with TAVI, 1880 (58.8%) had no-episode, 937 (29.3%) had single-episode, and 378 (11.9%) had multiple-episode. Both 30-day and cumulative 1-year mortality increased significantly across the 3 groups (7.7% vs. 9.2% vs. 15.9%; p < 0.001, 14.0% vs. 19.4% vs. 24.1%; p < 0.001, respectively). In addition, single-PO was not independently associated with an increased mortality at 30-day and 1-year compared to no-PO (HR: 0.99; 95% CI: 0.75-1.30; p = 0.923, HR: 1.15; 95% CI: 0.94-1.39; p = 0.173, respectively). In contrast multiple-PO was independently associated with an increased risk of both 30-day and cumulative 1-year mortality (HR: 1.51; 95% CI: 1.10-2.01; p = 0.012, HR: 1.30; 95% CI: 1.01-1.66; p = 0.043, respectively).ConclusionMultiple-PO, but not single, within the year preceding the index procedure is independently associated with increased mortality at short- and mid-term follow up after TAVI.