Short‐term outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation in the United States

Abstract

Objective We aimed to compare short‐term outcomes between transcatheter aortic valve replacement (TAVR) for pure aortic regurgitation (AR) and TAVR for aortic stenosis (AS). Background In patients with severe pure AR for whom surgical valve replacement is infeasible, TAVR is sometimes used off‐label. Methods Using the Nationwide Readmissions Database 2016–2017, we retrospectively identified patients without prior valve surgery who underwent endovascular TAVR. We compared in‐hospital and 30‐day outcomes according to the type of aortic valve disease. Results A total of 81,542 eligible patients were divided into the pure AR (n = 1,222, 1.50%), pure AS (n = 72,690, 89.1%), and AS + AR (n = 7,630, 9.36%) groups. In unadjusted analyses, the pure AR group, compared with the pure AS and AS + AR groups, showed a higher incidence of acute kidney injury (16.8% vs. 9.8% vs. 12.1%, respectively; p < .001) and need of surgical bailout (1.4% vs. 0.4% vs. 0.6%; p < .01). The pure AR group also showed higher in‐hospital mortality than the pure AS group (2.4% vs. 1.4%; p = .005). After multivariable adjustment, TAVR for pure AR was significantly associated with a higher risk of acute kidney injury (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.33–2.02; p < .001), cardiac tamponade (OR = 1.98, 95% CI = 1.00–3.92; p = .0498), and prolonged hospital stay (OR = 1.59, 95% CI = 1.29–1.95; p < .001) compared with TAVR for pure AS, whereas it was not significantly associated with in‐hospital mortality (OR = 1.55, 95% CI = 0.99–2.45; p = .058) and other outcomes. Conclusions TAVR may be a reasonable treatment option for selected patients with pure AR with regard to short‐term outcomes. However, additional techniques or devices may be necessary to reduce periprocedural risk.

Transfemoral Transcatheter Aortic Valve Replacement for Pure Native Aortic Regurgitation: One-Year Outcomes of a Single-center study

“…Only one patient (1/41, 2.4%) had new permanent pacemaker who developed a third-degree atrioventricular block 10 months after the procedure. Overall, the complications are less frequent than other studies using self-expanding valves [23][24].…”

Modified valve-in-valve bailout technique of transcatheter aortic valve replacement in severe aortic regurgitation for valve jumping up to ascending aorta: a case report

“…Surgical bailout is a usual option and more reported in pure AR patients undergoing TAVR. 10 Most pure AR patients undergoing TAVR are high-risk surgical risk, and surgical bailout will lead to adverse events including death. In this case, the head of the ablation catheter has the steerable characteristics, which can help capture the migrated valve and push it back to annulus more easily.…”

A case report of ventricular septal defect complicating transcatheter aortic valve implant for aortic regurgitation: novel complication and technical considerations

“…However, when compared with TAVI for AS results for AR are associated with increased in-hospital mortality. 4 , 7 , 8 Two comparative studies noted a lower device success rate for AR (76.9–81.8% vs. 91.3–96.0%) and more complications, particularly AKI and paravalvular leak. 7 , 8 In another retrospective analysis, heart block requiring permanent pacemaker insertion occurred in 18.2% and need for second valve implantation in 16.6%.…”

“… 3 The evidence-based however is lacking and other studies indicate higher complication rates. 4 , 5 This is generally attributed to difficulty anchoring the prosthesis in a non-calcified aortic valve. Here, we provide the first description of a traumatic ventricular septal defect (VSD) that occurred during implantation of a self-expanding valve prosthesis.…”