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INFECTIOUS ENDOCARDITIS

Prevalence and severity of paravalvular regurgitation in the Artificial Valve Endocarditis Reduction Trial (AVERT) echocardiography study

Victor G. Dávila-Román, MD, FACC^*,*, Alan D. Waggoner, RDCS, MHS^*, Elizabeth D. Kennard, PhD, Richard Holubkov, PhD, W. R. Eric Jamieson, MD, Lars Englberger, MD^||, Thierry P. Carrel, MD^|| and Hartzell V. Schaff, MD^¶

^* AVERT Echocardiography Core Laboratory and the Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
AVERT Coordinating Center, University of Pittsburgh, Pittsburgh, Pennsylvania
Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
St. Paul's Hospital, Vancouver BC, Canada
^|| Inselspital Bern, Bern, Switzerland
^¶ Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota

Manuscript received June 6, 2003; revised manuscript received November 17, 2003, accepted December 9, 2003.

^* Reprint requests and correspondence: Dr. Victor G. Dávila-Román, Director, Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Box 8086, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110 (Email: vdavila{at}im.wustl.edu).

OBJECTIVES: The purpose of this study was to determine the prevalence and severity of paravalvular regurgitation (PVR) in the Artificial Valve Endocarditis Reduction Trial (AVERT) cohort.

BACKGROUND: The initial AVERT cohort consisted of 807 patients randomized to receive either a Silzone-coated prosthetic valve or a conventional prosthetic valve; early clinical reports showed higher rates of valve explant caused by PVR for Silzone-coated prosthetic valve.

METHODS: Of the 678 eligible patients, 575 (85%) underwent postoperative transthoracic echocardiograms. The presence and severity of PVR were identified by color flow Doppler. Reviewers were blinded to the type of prosthetic valve and the demographic and clinical variables.

RESULTS: Among those who underwent echocardiography (Silzone-coated prosthetic valve, n = 285 and conventional prosthetic valve, n = 290), 59% had prosthetic aortic valves, 32% prosthetic mitral valves, and 9% had both; demographic and clinical findings (i.e., prosthetic valve endocarditis, thromboembolism, bleeding, and all-cause death) were similar for the two groups. Echocardiographically determined PVR was present in 50 valves: Silzone-coated prosthetic valve, 29 of 285 (10%) and conventional prosthetic valve, 21 of 290 (7%, p = NS); the severity of PVR was similar in both groups. Kaplan-Meier analysis showed no significant differences in PVR at 24 months from valve implantation between the two groups (24-month event-free rate: 93% Silzone-coated prosthetic valve vs. 94% conventional prosthetic valve, p = NS).

CONCLUSIONS: Excluding those patients who had initial prosthetic valve explant, the two-year echocardiographic follow-up of the AVERT cohort shows no statistically significant differences in the prevalence or severity of PVR in the Silzone-coated prosthetic valve compared with the conventional prosthetic valve. Further monitoring is warranted to determine whether these clinical outcomes remain similar on long-term follow-up.

Abbreviations and Acronyms   AVERT = Artificial Valve Endocarditis Reduction Trial   AVR = aortic valve replacement   LAA = left atrial area   LV = left ventricular   LVOT = left ventricular outflow tract   MVR = mitral valve replacement   PASP = pulmonary artery systolic pressure   PVE = prosthetic valve endocarditis   PVR = paravalvular regurgitation   RJA = regurgitant jet area   TTE = transthoracic echocardiography   TVI = time-velocity integral

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