Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation

J Am Coll Cardiol. 2017 Dec 5;70(22):2752-2763. doi: 10.1016/j.jacc.2017.10.006.

Abstract

Background: Limited data exist about safety and efficacy of transcatheter aortic valve replacement (TAVR) in patients with pure native aortic regurgitation (AR).

Objectives: This study sought to compare the outcomes of TAVR with early- and new-generation devices in symptomatic patients with pure native AR.

Methods: From the pure native AR TAVR multicenter registry, procedural and clinical outcomes were assessed according to VARC-2 criteria and compared between early- and new-generation devices.

Results: A total of 331 patients with a mean STS score of 6.7 ± 6.7 underwent TAVR. The early- and new-generation devices were used in 119 patients (36.0%) and 212 patients (64.0%), respectively. STS score tended to be lower in the new-generation device group (6.2 ± 6.7 vs. 7.6 ± 6.7; p = 0.08), but transfemoral access was more frequently used in the early-generation device group (87.4% vs. 60.8%; p < 0.001). Compared with the early-generation devices, the new-generation devices were associated with a significantly higher device success rate (81.1% vs. 61.3%; p < 0.001) due to lower rates of second valve implantation (12.7% vs. 24.4%; p = 0.007) and post-procedural AR ≥ moderate (4.2% vs. 18.8%; p < 0.001). There were no significant differences in major 30-day endpoints between the 2 groups. The cumulative rates of all-cause and cardiovascular death at 1-year follow-up were 24.1% and 15.6%, respectively. The 1-year all-cause mortality rate was significantly higher in the patients with post-procedural AR ≥ moderate compared with those with post-procedural AR ≤ mild (46.1% vs. 21.8%; log-rank p = 0.001). On multivariable analysis, post-procedural AR ≥ moderate was independently associated with 1-year all-cause mortality (hazard ratio: 2.85; 95% confidence interval: 1.52 to 5.35; p = 0.001).

Conclusions: Compared with the early-generation devices, TAVR using the new-generation devices was associated with improved procedural outcomes in treating patients with pure native AR. In patients with pure native AR, significant post-procedural AR was independently associated with increased mortality.

Keywords: aortic regurgitation; transcatheter valve implantation.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / surgery*
  • Aortic Valve Insufficiency* / diagnosis
  • Aortic Valve Insufficiency* / mortality
  • Aortic Valve Insufficiency* / surgery
  • Catheterization, Peripheral / methods
  • Catheterization, Peripheral / statistics & numerical data
  • Female
  • Femoral Artery / surgery*
  • Heart Valve Prosthesis* / adverse effects
  • Heart Valve Prosthesis* / standards
  • Humans
  • International Cooperation
  • Male
  • Mortality
  • Outcome and Process Assessment, Health Care
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / epidemiology
  • Prosthesis Design / trends
  • Quality Improvement
  • Registries / statistics & numerical data
  • Risk Assessment
  • Severity of Illness Index
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / instrumentation
  • Transcatheter Aortic Valve Replacement* / methods
  • Transcatheter Aortic Valve Replacement* / statistics & numerical data