TAVR Feasible for Inoperable Patients With Native Aortic Valve Regurgitation

Transcatheter aortic valve replacement (TAVR) may be a treatment option for selected patients with pure native aortic valve regurgitation (NAVR) who cannot undergo surgery.

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The study, published on Feb. 20 in the Journal of the American College of Cardiology, found that TAVR is feasible in this high-risk population but is also associated with complications.

The retrospective analysis looked at outcomes of 43 patients with severe, echocardiographically confirmed NAVR who underwent TAVR with the CoreValve prosthesis. Procedural success was achieved in 74.4 percent of patients. There was an all-cause 30-day mortality rate of 9.3 percent, and 2.3 percent of these deaths were attributed to cardiovascular causes. The 30-day major stroke rate was 4.7 percent and major bleeding complications occurred in 18.6 percent. Post-procedural grade II or III aortic regurgitation was observed in 16.3 percent and 4.7 percent of patients, respectively. At one year, the all-cause mortality rate was 21.4 percent and the cardiovascular death rate 10.7 percent.

The investigators noted that high rates of residual regurgitation and the need for two valves are important considerations, but concluded that, "this study analysis demonstrates the feasibility and potential procedure difficulties of treating patients with pure severe NAVR without aortic stenosis who have been deemed unsuitable for surgery with TAVR using the Medtronic CoreValve. Despite the variations in causes of valvular regurgitation and complexity of patient anatomy, acceptable results in this high-risk group of patients can be achieved."

Keywords: Heart Valve Prosthesis, Stroke, Heart Valve Diseases, United States, Echocardiography

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