Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation

David A. Roy, Ulrich Schaefer, Victor Guetta, David Hildick-Smith, Helge Möllmann, Nicholas Dumonteil, Thomas Modine, Johan Bosmans, Anna Sonia Petronio, Neil Moat, Axel Linke, Cesar Moris, Didier Champagnac, Radoslaw Parma, Andrzej Ochala, Diego Medvedofsky, Tiffany Patterson, Felix Woitek, Marjan Jahangiri, Jean Claude LabordeStephen J. Brecker

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1577-1584
Number of pages8
JournalJournal of the American College of Cardiology
Volume61
Issue number15
DOIs
StatePublished - 16 Apr 2013
Externally publishedYes

Keywords

  • native aortic valve regurgitation
  • transcatheter aortic valve implantation

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