{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T10:27:02Z","timestamp":1768040822418,"version":"3.49.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,7,16]]},"abstract":"\n Background<\/jats:title>\n \n Balloon postdilation (\n BPD<\/jats:styled-content>\n ) has emerged as an effective strategy to reduce paravalvular regurgitation (\n PVR<\/jats:styled-content>\n ) during transcatheter aortic valve replacement (\n TAVR<\/jats:styled-content>\n ). We investigated the utility of a time\u2010integrated aortic regurgitation index (\n TIARI<\/jats:styled-content>\n ) to guide balloon postdilation (\n BPD<\/jats:styled-content>\n ) after valve deployment.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n All consecutive patients who had echocardiography, aortography, and hemodynamic tracings recorded immediately after valve deployment during\n TAVR<\/jats:styled-content>\n were included in the study. Catheter\u2010derived invasive hemodynamic parameters were calculated offline. Among 157 patients who underwent\n TAVR<\/jats:styled-content>\n , 49 (32%) patients required\n BPD<\/jats:styled-content>\n to reduce significant\n PVR<\/jats:styled-content>\n after valve deployment. Two experienced operators decided whether the patients required\n BPD<\/jats:styled-content>\n for significant\n PVR<\/jats:styled-content>\n . Median\n TIARI<\/jats:styled-content>\n measured immediately after valve deployment was significantly lower in patients who required\n BPD<\/jats:styled-content>\n when compared with patients who did not require\n BPD<\/jats:styled-content>\n (\n P<\/jats:italic>\n <0.001). In a multivariable analysis, lower\n TIARI<\/jats:styled-content>\n (odds ratio: 0.81;\n P<\/jats:italic>\n =0.003) and higher\n PVR<\/jats:styled-content>\n grade on aortography and echocardiography (\n P<\/jats:italic>\n <0.001 for both) were associated with\n BPD<\/jats:styled-content>\n . Adding\n TIARI<\/jats:styled-content>\n to echocardiography and aortographic\n PVR<\/jats:styled-content>\n assessment resulted in a significant increase in global \u03c7\n 2<\/jats:sup>\n (\n P<\/jats:italic>\n <0.001), an integrated discrimination index of 9% (\n P<\/jats:italic>\n =0.002), and combined C\u2010statistics of 0.99 for predicting\n BPD<\/jats:styled-content>\n . Higher\n TIARI<\/jats:styled-content>\n after valve deployment was associated with better survival (hazard ratio: 0.94,\n P<\/jats:italic>\n =0.014), while other hemodynamic and imaging parameters did not predict mortality after\n TAVR<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Among patients undergoing\n TAVR<\/jats:styled-content>\n , a\n TIARI<\/jats:styled-content>\n measured immediately after valve deployment adds incremental value to guide\n BPD<\/jats:styled-content>\n over aortography and echocardiography. Higher residual\n TIARI<\/jats:styled-content>\n is associated with better survival after\n TAVR<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.012430","type":"journal-article","created":{"date-parts":[[2019,7,4]],"date-time":"2019-07-04T14:13:18Z","timestamp":1562249598000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Time\u2010Integrated Aortic Regurgitation Index Helps Guide Balloon Postdilation During Transcatheter Aortic Valve Replacement and Predicts Survival"],"prefix":"10.1161","volume":"8","author":[{"given":"Arnav","family":"Kumar","sequence":"first","affiliation":[{"name":"Division of Cardiology Andreas Gruentzig Cardiovascular Center Emory University School of Medicine Atlanta GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimi","family":"Sato","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yash","family":"Jobanputra","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Betancor","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Halane","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"George","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kinjal","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Divyanshu","family":"Mohananey","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Menon","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasser M.","family":"Sammour","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amar","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wael A.","family":"Jaber","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Mick","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars G.","family":"Svensson","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samir R.","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute Cleveland Clinic Foundation Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60308-7"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30073-3"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1200384"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202277"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu162"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.088"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/joic.12378"},{"key":"e_1_3_1_9_2","first-page":"451","article-title":"Standardized methodology for transfemoral transcatheter aortic valve replacement with the Edwards Sapien XT valve under fluoroscopy guidance","volume":"26","author":"Kasel AM","year":"2014","unstructured":"Kasel AM, Shivaraju A, Schneider S, Krapf S, Oertel F, Burgdorf C, Ott I, Sumer C, Kastrati A, von Scheidt W, Thilo C. 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