Transcatheter aortic valve replacement for aortic regurgitation in Asians

Abstract

Aims: Although surgical aortic valve replacement (SAVR) is currently the recommended intervention for patients with native AR without aortic stenosis, a significant proportion of Asian patients undergo transcatheter aortic valve replacement (TAVR), which has not been studied fully for safety and outcomes. This systematic review aims to examine the characteristics and outcomes of Asian patients with pure native aortic regurgitation (AR) undergoing TAVR.Methods and results: PubMed, Embase, Scopus, Web of Science and Cochrane CENTRAL were systematically searched for randomised controlled trials, observational studies and case reports published from inception to 2 April 2020, involving patients of Asian ethnicity with pure native aortic regurgitation who had undergone TAVR. Our primary outcome was all-cause mortality, with secondary outcomes including all major complications. Five studies (n=274 patients) and eight case reports were included. Device success was reported in 94.9% of the patients, the all-cause mortality rate was 4.4%, 2.5% were converted to SAVR, 1.7% had post-operative paravalvular leak and 6.7% required permanent pacemaker implantation.Conclusions: TAVR has demonstrated acceptable safety and efficacy in Asian patients with pure AR displaying low mortality rates and few adverse outcomes.

Application of echocardiography in transcatheter aortic valve replacement in patients with severe aortic regurgitation and correlation analysis of postprocedural complications

“…15 To address this problem, larger valves are usually selected, but oversized valves may increase the risk of valve rupture and atrioventricular block. 16 In fact, the prevalence of perivalvular leakage after TAVR in patients with severe AS has been reported, mild leakage predominating, but moderate or even severe leakage occurring in a significant number of patients. 17,18 This is because irregular calcification of the valve may cause the released prosthetic valve to not fit tightly to the original annulus structure, resulting in perivalvular leakage.…”

“…The main concern with using TAVR to treat AR patients is the difficulty in prosthetic valve anchoring due to insufficient calcification and/or annular enlargement 15 . To address this problem, larger valves are usually selected, but oversized valves may increase the risk of valve rupture and atrioventricular block 16 …”

Mitral Valve Chordal Rupture Caused by Prosthetic Valve Migration after Transcatheter Aortic Valve Implantation

“…Soong et al . 4 conducted a statistical study of TAVI for AR in Asians. The results indicated that TAVI has an acceptable safety and efficacy profile in native Asian patients with AR, with low mortality rates and generally good outcomes.…”

Transcatheter Aortic Valve Embolization in a Patient With a Left Ventricular Assist Device

“… 3 Transcatheter aortic valve implantation (TAVI) is established as an alternative to open surgery in patients with aortic stenosis (AS) and is gaining popularity for AR in high-risk AR patients who would not be good candidates for a surgical aortic valve replacement (SAVR). 4 Studies have been performed to compare in-hospital mortality between patients with SAVR versus TAVI, and no significant differences in outcomes were found. 5 Despite being a more challenging procedure, prior case reports have proven that TAVI for AR has been successfully performed on patients who have an LVAD.…”