Usefulness of Transcatheter Aortic Valve Implantation for Treatment of Pure Native Aortic Valve Regurgitation

Backer, Ole De; Pilgrim, Thomas; Simonato, Matheus; Mackensen, G. Burkhard; Fiorina, Claudia; Veulemanns, V.; Cerillo, Alfredo Giuseppe; Schöfer, Joachim; Amabile, Nicolas; Achkouty, Guy; Schäfer, Ulrich; Deutsch, M; Sinning, Jan Malte; Rahman, Mohammed Shamim; Sawaya, Fadi J.; Hildick‐Smith, David; Hernández, José M. de la Torre; Kim, Won Keun; Lefèvre, Thierry; Seiffert, Moritz; Bleiziffer, Sabine; Petronio, Anna Sonia; Mieghem, Nicolas Van; Taramasso, Maurizio; Søndergaard, Lars; Windecker, Stephan; Latib, Azeem; Dvir, Danny

doi:10.1016/j.amjcard.2018.05.044

Cited by 57 publications

(57 citation statements)

References 14 publications

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“…Prior studies have demonstrated the higher dose of contrast agents required during TAVR for pure AR (median volume, 150–180 ml/procedure 10,12 ) than TAVR for AS (80–110 ml/procedure 23,24 ). In addition, patients with AR often have a large aortic annulus, which can lead to further difficulty in valve anchoring and increases the risk of valve embolization and migration 11 . In the present study, the higher risk of AKI may also have led to a longer length of stay in TAVR for pure AR due to the need for observation of kidney function.…”

Section: Discussionmentioning

confidence: 71%

“…In the present study, the higher risk of AKI may also have led to a longer length of stay in TAVR for pure AR due to the need for observation of kidney function. Importantly, a previous study has demonstrated that patients who developed AKI with TAVR for pure AR had higher mortality at one‐year after TAVR 11 . Other investigators have shown that procedure time is longer in TAVR for pure AR, 10,12,23,24 possibly increasing the risk of procedure‐related bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…There have been limited studies regarding the outcomes of TAVR for pure AR. Most of the studies focused on the evaluation of feasibility and procedural outcomes of TAVR for pure AR and have shown that TAVR for pure AR is a challenging but feasible procedure especially when the newer generation TAVR devices for AS are used 10–14, 22 . Although these previous studies provided us important clinical and procedural information on TAVR for AR, scarce data are available highlighting the direct comparison of outcomes between TAVR for pure AR and AS.…”

Section: Discussionmentioning

confidence: 99%

“…TAVR for pure AR is technically more challenging than that for AS because AR is often associated with a large aortic annulus and few valve calcifications, leading to difficulty in valve anchoring and increased risks for valve embolization and migration 8,9 . Although previous studies have demonstrated the feasibility of TAVR for pure AR, 10‐14 little is known about the differences in outcomes between TAVR for pure AR and TAVR for AS. Therefore, this study aimed to investigate the differences in short‐term outcomes among TAVR patients according to the type of aortic valve disease.…”

Section: Introductionmentioning

confidence: 99%

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

Isogai

Saad

Ahuja

et al. 2020

Cathet Cardio Intervent

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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.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Isogai

Saad

Ahuja

et al. 2020

Cathet Cardio Intervent

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“…The authors found no causal explanation for this phenomenon other than valve design and absence of calcification. [48]…”

Section: Tavi For Npar: Evidence On New Generation Devicesmentioning

confidence: 99%

TAVI for Pure Native Aortic Regurgitation: Are We There Yet?

et al. 2019

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Treatment of degenerative aortic stenosis has been transformed by transcatheter aortic valve implantation (TAVI) over the past 10–15 years. The success of various technologies has led operators to attempt to broaden the indications, and many patients with native valve aortic regurgitation have been treated ‘off label’ with similar techniques. However, the alterations in the structure of the valve complex in pure native aortic regurgitation are distinct to those in degenerative aortic stenosis, and there are unique challenges to be overcome by percutaneous valves. Nevertheless some promise has been shown with both non-dedicated and dedicated devices. In this article, the authors explore some of these challenges and review the current evidence base for TAVI for aortic regurgitation.

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

et al. 2023

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ImportanceThe management of aortic valve disease, including aortic stenosis and aortic regurgitation (AR), in younger adult patients (age &lt;65 years) is complex, and the optimal strategy is often unclear, contingent on multiple anatomic and holistic factors.ObservationsTraditional surgical approaches carry significant considerations, including compulsory lifelong anticoagulation for patients who receive a mechanical aortic valve replacement (AVR) and the risk of structural valvular deterioration and need for subsequent valve intervention in those who receive a bioprosthetic AVR. These factors are magnified in young adults who are considering pregnancy, for whom issues of anticoagulation and valve longevity are heightened. The Ross procedure has emerged as a promising alternative; however, its adoption is limited to highly specialized centers. Valve repair is an option for selected patients with AR. These treatment options offer varying degrees of durability and are associated with different risks and complications, especially for younger adult patients. Patient-centered care from a multidisciplinary valve team allows for discussion of the optimal timing of intervention and the advantages and disadvantages of the various treatment options.Conclusions and RelevanceThe management of severe aortic valve disease in adults younger than 65 years is complex, and there are numerous considerations with each management decision. While mechanical AVR and bioprosthetic AVR have historically been the standards of care, other options are emerging for selected patients but are not yet generalizable beyond specialized surgical centers. A detailed discussion by members of the multidisciplinary heart team and the patient is an integral part of the shared decision-making process.

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Usefulness of Transcatheter Aortic Valve Implantation for Treatment of Pure Native Aortic Valve Regurgitation

Cited by 57 publications

References 14 publications

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

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

TAVI for Pure Native Aortic Regurgitation: Are We There Yet?

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

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