Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation

Yoon, Sung Han; Schmidt, Tobias; Bleiziffer, Sabine; Schofer, Niklas; Fiorina, Claudia; Muñoz-García, Antonio J.; Yzeiraj, Ermela; Amat‐Santos, Ignacio J.; Tchétché, Didier; Jung, Christian; Fujita, Buntaro; Mangieri, Antonio; Deutsch, M; Ubben, Timm; Deuschl, Florian; Kuwata, Shingo; Biase, Chiara De; Williams, Timothy; Dhoble, Abhijeet; Kim, Won Keun; Ferrari, Enrico; Barbanti, Marco; Vollema, E. Mara; Miceli, Antonio; Giannini, Cristina; Attizzani, Guiherme; Kong, William Kok-Fai; Gutiérrez‐Ibañes, Enrique; Díaz, Víctor Alfonso Jiménez; Wijeysundera, Harindra C.; Kaneko, Hidehiro; Chakravarty, Tarun; Makar, Moody; Sievert, Horst; Hengstenberg, Christian; Prendergast, Bernard; Vincent, Flavien; Abdel‐Wahab, Mohamed; Nombela‐Franco, Luis; Silaschi, Miriam; Tarantini, Giuseppe; Butter, Christian; Ensminger, Stephan; Hildick‐Smith, David; Petronio, Anna Sonia; Yin, Wei Hsian; Marco, Federico De; Testa, Luca; Mieghem, Nicolas Van; Whisenant, Brian; Kuck, Karl Heinz; Colombo, Antonio; Kar, Saibal; Morís, César; Delgado, Victoria; Maisano, Francesco; Nietlispach, Fabiàn; Mack, Michael J.; Schöfer, Joachim; Schäefer, Ulrich; Bax, Jeroen J.; Frerker, Christian; Latib, Azeem; Makkar, Raj

doi:10.1016/j.jacc.2017.10.006

Cited by 236 publications

(208 citation statements)

References 28 publications

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“…Since 2015, second‐generation valve systems were widely used, which could explain the better outcomes over the recent years besides improved patient selection and learning curves. A registry including over 300 patients with pure AR undergoing TAVR confirmed that treatment with second‐generation TAVR valves might achieve improved 1‐year outcomes . Therefore, convincing results with TAVR seem to be possible, assuming a thorough patient and TAVR‐valve selection in clinical practice.…”

Section: Discussionmentioning

confidence: 97%

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Stachon

Kaier

Heidt

et al. 2019

Cathet Cardio Intervent

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Background Transcatheter aortic valve replacement (TAVR) is routinely used in patients with severe aortic stenosis at increased operative risk. Due to potential technical difficulties, TAVR is not recommended for pure aortic regurgitation (AR). Smaller studies reported its use in AR, but data from big registries are lacking. The present study analyzes the nationwide use of surgical aortic valve replacement (SAVR) and TAVR in patients with AR from 2008 until 2015. Methods We identified 138,237 cases of aortic valve replacement in Germany based on ICD and OPS codes. Results Of 13.2% SAVR‐cases and 1.3% of TAVR cases were performed in AR. AR patients undergoing SAVR were younger with lower logistic EuroSCORE (stenosis: 6.1 ± 5.6; AR: 4.5 ± 4.9). Nevertheless, stroke rates, bleedings, prolonged mechanical ventilation, and in‐hospital mortality were higher (mortality: stenosis 2.6%, AR: 4.7%). In the TAVR group, patients with AR were at higher operative risk (logistic EuroSCORE: transfemoral (TF)‐TAVR: stenosis: 14.3 ± 10.4; AR: 17.3 ± 13.3. Transapical (TA)‐TAVR: stenosis: 16.1 ± 11.4; AR: 15.7 ± 12.2). Stroke rates were lower, but bleedings and prolonged ventilation occurred more frequently after TF‐TAVR in AR compared to stenosis. The mortality varied markedly (TF‐TAVR: 15.2% in 2011; 2.8% in 2015; TA‐TAVR: 17.7% in 2012 and 0% in 2014). Conclusion TAVR is off‐label used in AR in clinical practice. TAVR seems to be a safe option for AR with regard to in‐hospital outcomes. However, further research evaluating long‐term outcomes is required to establish the feasibility of TAVR in pure AR.

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Section: Discussionmentioning

confidence: 97%

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Stachon

Kaier

Heidt

et al. 2019

Cathet Cardio Intervent

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“…Compared to the early-generation devices, the new ones 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 and post-procedural AR (more than moderate). The cumulative rates of all-cause and cardiovascular death at 1-year follow-up were similar and post-procedural AR was independently associated with worse outcomes [42] . Similar findings were showed by Franzone et al [43] that confirmed TAVI as technically feasible in AR patients, with acceptable early morbidity and mortality rates [43] .…”

Section: Patients With Pure Aortic Regurgitationmentioning

confidence: 79%

“…However, limited data exist about safety and efficacy of TAVI in this specific subset of patients, mainly reported in several case reports and small clinical studies. Yoon et al [42] enrolled 331 patients with symptomatic, severe pure native AR undergoing TAVI across 40 participating centers between September 2007 and February 2017. The aim of this study was to compare the outcomes of TAVI with early-and new-generation prosthesis devices in symptomatic patients with pure AR.…”

Section: Patients With Pure Aortic Regurgitationmentioning

confidence: 99%

Who is the next for aortic valve implantation? Present and future indications

Verolino¹,

Veneri²,

Carpenito³

et al. 2018

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Aortic valve stenosis (AS) represents the most prevalent valvular defect worldwide. It is a progressive disease with a long latency interval and a poor prognosis after symptoms present. According to current European Society of Cardiology guidelines, transcatheter aortic valve implantation (TAVI) is recommended in all patients with severe symptomatic AS and a predicted survival longer than one year, who are not suitable for surgical valve replacement. Despite these recommendations, several studies over the past few years suggest extending these indications towards lower risk AS populations. Otherwise, current available operative risk scores such as Society of Thoracic Surgeons score and EuroSCORE, may offer an incomplete risk assessment; in this setting, the Heart Team plays a crucial role in defining the most appropriate therapeutic strategy in patients with AS. In this review, we aim to discuss the current and future indications for TAVI, analyzing available literature according to patients' profile risk (high/mid/low risk) and other specific conditions (valve-in-valve, bicuspid valve and pure aortic regurgitation).

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“…Newer devices had higher device success rate (81% vs 61%; P < 0.001), and lower post‐procedural AR > moderate (4% vs 19%; P < 0.001). At 1 year, cardiovascular mortality was lower in patients who received newer devices (10% vs 24%, P = 0.008) …”

Section: Adjunctive Therapies and Imaging In Tavrmentioning

confidence: 99%

Transcatheter aortic valve replacement: The year in review 2017

Thakur

Nazif

Khalique

et al. 2018

J Interven Cardiology

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This article is a continuation of our previously published annual reviews of transcatheter aortic valve replacement (TAVR). In 2017, TAVR further established a foothold in the management of intermediate risk patients with the publication of SURTAVI trial. Randomized trials also addressed the use of cerebral protection during TAVR and single versus dual antiplatelet therapy after TAVR. Newer generation valve systems continued to be studied for their efficacy and safety. This paper summarizes the major studies published in 2017.

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Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation

Cited by 236 publications

References 28 publications

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Who is the next for aortic valve implantation? Present and future indications

Transcatheter aortic valve replacement: The year in review 2017

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