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Transcatheter Aortic Valve Implantation for Pure Severe Native Aortic Valve Regurgitation
Study Questions:
Is transcatheter aortic valve implantation (TAVI) a feasible procedure for patients with pure aortic valve regurgitation (AR)?
Methods:
This registry evaluated 43 surgically inoperable patients with pure severe AR treated with TAVI (Medtronic CoreValve, Minneapolis, MN) at 14 centers; patients with concomitant aortic stenosis or prior valve replacement were not included. Procedural success, post-procedure AR, and outcomes including stroke and mortality were evaluated.
Results:
Mean age was 75.3 ± 8.8 years, and 53% were female. Mean Society of Thoracic Surgeons score was 10.2 ± 5.3%. Deployment of the TAVI prosthesis was achieved in 42/43 patients (98%). A second valve was required in 8/26 patients (31%) without aortic valve calcification, whereasnone of the 17 individuals with aortic valve calcification required a second valve (p = 0.01). Post-procedure, 79% of individuals had ≤ grade I AR. The 30-day and 12-month all-cause mortality was 9.3% and 21.4%, respectively; 30-day and 12-month cardiovascular mortality was 2.3% and 10.7%. Major stroke at 30 days was observed in 4.7% of patients.
Conclusions:
The authors concluded that TAVI represents a feasible procedure for individuals with severe AR who are deemed not to be surgical candidates. The absence of aortic valve calcification appears to identify patients who may require a second valve.
Perspective:
TAVI has been successfully utilized in many patients with severe aortic stenosis with or without AR in clinical trials. In contrast to patients with aortic stenosis, individuals with pure AR may have differences in valve morphology that include reduced or no calcification, which may present challenges in appropriately anchoring the TAVI prosthesis in the aortic valve annulus. This study demonstrates a high overall success rate in otherwise inoperable patients, although many patients with absent valve calcification required a second valve. It is unclear whether alterations in deployment techniques, improved valve sizing using CT (only used in 44% of study patients), or increased site experience in treating these patients may address these limitations. While these early data are promising, larger prospective studies with long-term follow-up are needed to define the clinical utility of TAVI in these patients.
Keywords: Prostheses and Implants, Stroke, Follow-Up Studies, Cardiology, Calcinosis, Heart Valve Prosthesis Implantation, Angioplasty
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