Less invasive treatments for pure aortic insufficiency: Are we there yet?

Forcillo, Jessica

doi:10.1111/jocs.16237

Cited by 1 publication

(1 citation statement)

References 18 publications

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“…TAVR has been described in heart transplant patients as early as 2010 [ 1 ], and has been attempted at increasing intervals from the original transplant, with cases showing success at 9 [ 1 ], 14 [ 2 ], and greater than 20 years after transplant in patients with aortic stenosis [ 3 , 4 ]. Similarly, TAVR has begun to be used off-label to treat aortic insufficiency in similar patient populations with good results [ 5 ]. While ongoing questions remain about the comparative long-term efficacy of TAVR for aortic insufficiency when compared to surgical valve replacement [ 6 ], for select patients with significant surgical risk, early data show TAVR to be a viable option for patients with unacceptable surgical risk [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement 23 years after heart transplant for aortic insufficiency

Jones,

Amirjamshidi,

Olverson

et al. 2023

J Cardiothorac Surg

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Background Clinicians continue to expand the availability of transcatheter aortic valve replacement (TAVR) for patients who historically would have been ineligible for surgical aortic valve replacement. Historically, reoperative aortic valve surgery after transplant was immensely complicated and high risk due to the repeat sternotomy approach, and the immunosuppression in transplant patients. As heart transplant patients continue to live longer, patients are beginning to develop novo aortic pathology of the transplanted organ. In these patients, TAVR may be a valuable rescue therapy for those with de-novo aortic valve disease. Case presentation Here, we present a single case of a 70-year-old man with a history of heart transplant 23 years prior complicated by severe sternal infection and subsequent removal of his sternum. Additionally, this patient had a recent history of kidney transplant due to renal cell carcinoma necessitating nephrectomy. He subsequently developed progressive symptomatic aortic insufficiency and underwent a successful TAVR to treat his new aortic disease. Conclusions To our knowledge, this represents only the second case report of TAVR for severe aortic insufficiency and one of the first reports of TAVR in a multiple organ recipient. TAVR may represent an important rescue therapy for post-transplant valve pathologies instead of high-risk reoperative surgical aortic valve replacement.

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