Transcatheter aortic valve replacement in pure native aortic regurgitation: when off-label indications match the patientÓ?s requirements

Abstract

Objective: In recent years, transcatheter aortic valve replace (TAVR) has revolutionized the interventional treatment of aortic stenosis, however, only scarce evidence considers it as treatment for Aortic Regurgitation (AR). At present, the treatment of Pure AR of Native Valve with TAVR does not fall within the recommendations of international guidelines, as it poses multiple challenges with immediate and long-term variable and unpredictable results. The objective of this paper is to present the case of a patient with prohibitive operative risk that benefited of TAVR treatment for AR. Materials and methods: We present the case of a 79-year-old male patient who has severe Pure Native Aortic Valve Regurgitation, considered inoperable. Based on the heart team's decision, TAVR was planned with the use of an Edwards SAPIEN 3 valve. After TAVR, the patient developed complete heart block and a pacemaker was implanted. He improved to NYHA II functional class. At 15-month follow-up, he suffered intracranial hemorrhage and passed away. Results and Conclusions: Management of patients with severe symptomatic AR with high surgical risk continues to be a special challenge. They have high mortality if left untreated with valvular change, despite medical treatment. Even though it is strictly off-label, TAVR might be a reasonable solution for a select type of patients who are considered inoperable due to surgical high mortality risk.

Remote ischaemic preconditioning for transcatheter aortic valve replacement: a protocol for a systematic review with meta-analysis and trial sequential analysis

“…Based on the improving outcomes of TAVR, its indications have expanded from high to intermediate surgical risks, and younger populations with low surgical risks are also included 10–14. In addition, the initiated indications also extend from isolated severe aortic stenosis to mixed aortic valve disease and pure native aortic regurgitation disease 15–19. With the broadening of indications, the collected data from the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC)/Transcatheter Valve Therapy (TVT) Registry indicate that TAVR volumes first exceeded isolated SAVR volumes between 2015 and 2016 and then exceeded all forms of SAVR volumes between 2018 and 2019 20 21…”

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

“…Transcatheter aortic valve implantation (TAVI) has revolutionized interventional treatment of aortic stenosis in recent years, but there is limited evidence for TAVI as a treatment option for severe aortic regurgitation (AR). 1 Because of its minimal trauma and rapid recovery, there is global consensus that TAVI is a feasible and potential alternative treatment for older adults who cannot tolerate surgical aortic valve replacement. 2 , 3 However, because of the technical surgical challenges and unpredictable postoperative risks, TAVI is not recommended for isolated severe AR in international guidelines.…”