TAVR for Pure Aortic Regurgitation

Study Questions:

What are the outcomes in patients treated with transcatheter aortic valve replacement (TAVR) for pure aortic regurgitation (AR)?

Methods:

This meta-analysis examined 237 patients from 13 reports of patients with pure AR treated with TAVR, and examined patient and procedural characteristics and all-cause mortality.

Results:

From 237 selected patients treated with TAVR for pure AR, self-expandable and balloon-expandable prostheses were used in 79% and 21% of cases, respectively. Procedural success ranged from 74% to 100%, and all-cause mortality was 7% at 30 days (range 0%-30%). Adverse events included stroke (<1%), permanent pacemaker implantation (11%), acute kidney injury (7%), major bleeding (2%), and at least moderate residual AR (9%).

Conclusions:

The selected use of TAVR in patients with pure AR has a moderate to high reported success rate, with a relatively low although variable rate of short-term mortality.

Perspective:

The use of TAVR for pure AR presents several potential challenges, as these devices are specifically designed for stenotic aortic valves. Patients with pure AR often have less valve calcification, which can limit the ability of valves to anchor in position, and the high stroke volume associated with AR can make optimal valve deployment more challenging. These data suggest that TAVR in pure AR may be feasible, and can be associated with fairly good outcomes, although these cases likely represent highly selected patients, and the rate of mortality at 30 days had a large range (0-30%). Based on these results, it may be reasonable to consider TAVR for pure AR on a case-by-case basis when patients are not candidates for surgical aortic valve replacement, but we need longer-term follow-up and randomized trials to determine the appropriate role of TAVR in this population.


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