Severe aortic regurgitation: the limits of TAVI

Transcatheter aortic valve implantation (TAVI) is a well-established treatment for symptomatic severe aortic stenosis, but its use in native aortic regurgitation (AR) still presents challenges. Patients with native severe AR frequently have a bicuspid aortic valve, large dimensions of the aortic annulus (frequently exceeding the nominal sizes of the available transcatheter heart valves [THV]) and a low aortic valve calcification load. These aortic valve features increase the risk of significant paravalvular regurgitation and prosthesis migration, which frequently needs conversion to surgical valve replacement. In addition, patients with severe AR often have various grades of aortic root dilatation with an indication for intervention. Symptoms, left ventricular dysfunction and the need for aortic root replacement are the main determinants for decision-making in patients with native severe AR. However, there is still a significant proportion of patients with native severe AR that remains untreated (up to 53%), and the observed mortality at 2 years is almost 21%1. Although the reasons for no intervention remain underexplored, older age, associated comorbidities and high operative risk may play an important role in decision-making.

TAVI using THV...