Transcatheter aortic valve replacement in aortic regurgitation: The U.S. experience

Abstract

Background: Transcatheter aortic valve replacement (TAVR) can be an effective option for high-risk Aortic Regurgitation (AR) patients. Although international experiences of TAVR for AR are published, U.S. data are limited. This study sought to report the short-term outcomes of TAVR in AR in the U.S. population. Methods: Study cohorts were derived from the Nationwide Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) 2016-17. TAVR and AR were identified using ICD-10-CM-codes. The key outcomes were all-cause mortality, disabling stroke, valvular complications, complete heart block (CHB)/permanent pacemaker placement (PPM), open-heart surgery, acute kidney injury (AKI) requiring dialysis, and vascular complications. Multivariate logistic regression was used to adjust for confounders.Results: 915 patients from the NIS (male-71%, age ≥65-84.2%) and 822 patients from the NRD (male-69.3%, age ≥65-80.5%) underwent TAVR for AR. The median length of stay (LOS) was 4 days for both cohorts. In-hospital mortality was 2.7%, and 30-day mortality was 3.3%. Disabling strokes were noted in 0.6% peri-procedurally and 1.8% at 30-days. Valve-related complications were 18-19% with paravalvular leak (4-7%) being the most common. Approximately 11% of patients developed CHB and/or needed PPM in both cohorts. In NRD, 2.2% of patients required dialysis for

Structural Transcatheter Cardiac Interventions in the Cardio-Oncology Population

“…This off-label use of TAVR is due to a growing number of patients being deemed to be high-risk surgical candidates, with a subset of them being cardio-oncology patients. A Nationwide Inpatient Sample study evaluated short-term outcomes in 915 patients who underwent TAVR for severe AR and revealed a 30-day all-cause mortality of 3.3%, which was similar to those of the PARTNER (3.4%) and PARTNER 2 (3.9%) trials, which evaluated the use of TAVR for severe AS [36]. TAVR is therefore a promising therapy for cancer patients with concomitant AR, though further data is necessary to validate the expansion of TAVR as a treatment option for AR.…”

Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease

“…When it comes to young patients with isolated severe native AR, the majority of whom have low surgical risk, TAVR for the management of severe AR should be considered only in selected high-risk patients, such as patients with AR related to an implanted left ventricular assist device or those without traditional surgical options. However, there are several technologies in ongoing clinical trials that are specifically designed for isolated AR …”

A novel anatomic classification to guide transcatheter aortic valve replacement for pure aortic regurgitation

“…13 The dimensions of the left ventricular outflow tract (LVOT), annulus, sinotubular junction (STJ), ascending aorta (AA) 40 mm above the annulus, and maximal AA were determined. Moreover, supraannular and AA multiplanar dimensions (2,4,6,8,10,30,35,40,45, and 50 mm above the annular plane) were also measured to identify the proper anchor levels for the THV (Figure 1).…”

“…The absence of calcium and the systematically associated dilated aortic root in AR are the main challenges for TAVR procedures with respect to the difficulty of transcatheter heart valve (THV) anchoring, leading to malposition and paravalvular regurgitation. Several registries in Western countries have reported current outcomes of TAVR in high surgical risk patients with pure AR, including rates of 30‐day mortality (9.3%–23%), new pacemakers (7.5%–27.3%), stroke (0%–4.7%), moderate‐to‐severe paravalvular regurgitation (20.9%–23%), and the need for a second THV (0%–24.4%) 6‐10 . These unsatisfactory results mainly stemmed from performing TAVR in patients with unfavorable aortic root anatomy and the technological limitations of the current devices.…”

“…Several registries in Western countries have reported current outcomes of TAVR in high surgical risk patients with pure AR, including rates of 30-day mortality (9.3%-23%), new pacemakers (7.5%-27.3%), stroke (0%-4.7%), moderateto-severe paravalvular regurgitation (20.9%-23%), and the need for a second THV (0%-24.4%). [6][7][8][9][10] These unsatisfactory results mainly stemmed from performing TAVR in patients with unfavorable aortic root anatomy and the technological limitations of the current devices.…”