Outcomes following transcatheter aortic valve replacement in patients with native aortic valve regurgitation

Abstract

Due to the absence of annular calcification for device anchoring, it is presumed that transcatheter aortic valve replacement (TAVR) is not suitable for the treatment of native aortic valve regurgitation (NAVR) resulting in very limited data and experience concerning its safety and efficacy. We sought to review published data on the safety and efficacy of TAVR in high-risk patients with NAVR. Studies including case reports, case series and original articles published between 2002 and 2016 on TAVR in patients with NAVR were identified with a systematic electronic search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. A total of 30 publications describing 182 patients were identified. Most patients (54%) were men, with a mean age of 70.1±2.6 years, mean logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) of 21.8%±4.5% and mean Society of Thoracic Surgeons (STS) score of 8%±1.8% for mortality. The majority (87%) of patients had severe NAVR with no valvular calcification. TAVR was mostly performed through the femoral (58.8%) and apical (33.1%) approach. Device success, defined by VARC-2, was achieved in 86.3% of our study population.A second valve was required in 17 patients (9.3%) during the index procedure for residual aortic regurgitation or malposition. Post-procedure aortic regurgitation of grade 1 or less was present in 80 patients (81%).Pacemaker implantation was required post procedure in 17 patients (9.3%). The 30-day and 1-year mortality was 11.9% and 16.2%, respectively. TAVR is associated with favorable pacemaker implantation and 1-year mortality rates with a high 30-day mortality among selected patients with NAVR.

A novel anatomic classification to guide transcatheter aortic valve replacement for pure aortic regurgitation

“…Three patients with Venus-A valves and 6 patients with VitaFlow valves required new permanent pacemaker placement after TAVR. The new permanent pacemaker placement rate in our study was similar to that reported in previous studies of pure AR (7,10,19,20). The two domestic valves used in this study were both first-generation devices, which were recommended to be released at a lower position because of their non-recapturable systems in patients with AR, thus being associated with a high risk of new permanent pacemaker placement.…”

Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations

“…Despite the systematic reviews covering the area of AV repair, evidence remains heterogenous and registries are underway to try and pool and analyse cohorts of patients undergoing AV repair. (27)Percutaneous intervention -TAVIAR is traditionally a contraindication to TAVI as the calcified landing zone is often lacking,(34) removing anatomical landmarks for alignment and potentially leading to malposition (35). Furthermore, increased movement of valve prosthesis in the regurgitant jet as well as aortic root dilatation may lead to suboptimal prosthesis position and paravalvular leak necessitating a second valve-in-valve prosthesis.…”

Commentary: Endovascular Repair of the Ascending Aorta: Have We Reached the Moon?

“…In fact, there remains a long way before we reach the moon: combining TEVAR and transcatheter aortic valve intervention in a smooth and non-calcified aortic valve. 11 We need not only courage but also innovation and new dedicated devices. 12…”