Clinical Research
Interventional Cardiology
Transcatheter Aortic Valve Implantation for Pure Severe Native Aortic Valve Regurgitation

https://doi.org/10.1016/j.jacc.2013.01.018Get rights and content
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Objectives

This study sought to collect data and evaluate the anecdotal use of transcatheter aortic valve implantation (TAVI) in pure native aortic valve regurgitation (NAVR) for patients who were deemed surgically inoperable

Background

Data and experience with TAVI in the treatment of patients with pure severe NAVR are limited.

Methods

Data on baseline patient characteristics, device and procedure parameters, echocardiographic parameters, and outcomes up to July 2012 were collected retrospectively from 14 centers that have performed TAVI for NAVR.

Results

A total of 43 patients underwent TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, Minnesota) at 14 centers (mean age, 75.3 ± 8.8 years; 53% female; mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation), 26.9 ± 17.9%; and mean Society of Thoracic Surgeons score, 10.2 ± 5.3%). All patients had severe NAVR on echocardiography without aortic stenosis and 17 patients (39.5%) had the degree of aortic valvular calcification documented on CT or echocardiography. Vascular access was transfemoral (n = 35), subclavian (n = 4), direct aortic (n = 3), and carotid (n = 1). Implantation of a TAVI was performed in 42 patients (97.7%), and 8 patients (18.6%) required a second valve during the index procedure for residual aortic regurgitation. In all patients requiring second valves, valvular calcification was absent (p = 0.014). Post-procedure aortic regurgitation grade I or lower was present in 34 patients (79.1%). At 30 days, the major stroke incidence was 4.7%, and the all-cause mortality rate was 9.3%. At 12 months, the all-cause mortality rate was 21.4% (6 of 28 patients).

Conclusions

This registry analysis demonstrates the feasibility and potential procedure difficulties when using TAVI for severe NAVR. Acceptable results may be achieved in carefully selected patients who are deemed too high risk for conventional surgery, but the possibility of requiring 2 valves and leaving residual aortic regurgitation remain important considerations.

Key Words

native aortic valve regurgitation
transcatheter aortic valve implantation

Abbreviations and Acronyms

CT
computed tomography
NAVR
native aortic valve regurgitation
TAVI
transcatheter aortic valve implantation
VARC
Valve Academic Research Consortium

Cited by (0)

Dr. Hildick-Smith receives consultancy fees from Biosensors, Boston Scientific, Gore, Medtronic, Occulotech, St. Jude Medical, Coherex, and Terumo. Dr. Dumonteil receives consultancy fees from Edwards Lifesciences, Medtronic, Boston Scientific, and Biotronic. Dr. Moat receives consultancy fees from Medtronic and Abbott Vascular. Dr. Linke receives consultancy fees from Edwards Lifesciences and Medtronic. Dr. Morris receives consultancy fees from Medtronic. Dr. Laborde receives consultancy fees from Medtronic. Dr. Brecker receives consultancy fees from Medtronic and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.