Treatment and consequences of regurgitation during transcatheter valve therapies
Transcatheter aortic valve implantation for pure severe native aortic regurgitation
Aims: Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with severe aortic valve stenosis and prohibitive or high surgical risk. There is limited data and experience for TAVI in the treatment of patients with pure severe native valve aortic regurgitation. We aimed to evaluate the off-label treatment of pure native aortic regurgitation (NAR) with TAVI for patients with prohibitive surgical risk by examining the procedural and clinical results from a retrospective worldwide registry of patients with NAR treated with TAVI.
Methods and results: Data on baseline patient characteristics, device and procedural parameters, echocardiographic parameters and outcomes up to June 2012 were collected retrospectively in a uniform spreadsheet from 14 centres that have performed TAVI for pure NAR. A total of 43 patients underwent TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, MN, USA) in 14 centres (mean age 75.3±8.8 years, 53% female, mean logistic EuroSCORE 26.9±17.9%, mean STS score of 10.2±5.3%, n=35 transfemoral, n=4 subclavian, n=3 direct aortic, n=1 carotid). The mean annulus size was 23.7±2.1 mm and the 29 mm prosthesis was most commonly used (n=21 29 mm, n=14 26 mm, n=1 31 mm). Implantation was successful in 42 patients (97.7%) and 8 (18.6%) patients required a second valve during the index procedure for residual aortic regurgitation. In all cases where a second valve was needed, annular calcification was absent (p=0.014). Post-procedure aortic regurgitation ≤ grade I was present in 34 patients (79.1%). All-cause mortality at 30 days was 9.3% (4 patients) and the incidence of major strokes was 4.7% at 30 days. At 12 months, the all-cause mortality was 21.4% (6/28 patients) with a cardiovascular mortality of 10.7% (3 patients).
Conclusions: This represents the first registry analysis of patients being treated with TAVI for the indication of pure severe NAR. TAVI for severe NAR is feasible and can be an effective treatment for patients with prohibitive surgical risk.
