Dataset Information

Transcatheter Aortic Valve Implantation for Severe Pure Aortic Regurgitation With Dedicated Devices.

ABSTRACT: Aortic regurgitation (AR) is not the most common valvular disease; however, its prevalence increases with age, with more than 2% of those aged >70 years having at least moderate AR. Once symptoms related to AR develop, the prognosis becomes poor. Transcatheter aortic valve implantation for patients with pure severe AR and at prohibitive surgical risk is occasionally performed, but remains a clinical challenge due to absence of valvular calcium, large aortic root and increased stroke volume. These issues make the positioning and deployment of transcatheter aortic valve implantation devices unpredictable, with a tendency to prosthesis embolisation or malposition. To date, the only two dedicated transcatheter valves for AR are the J-Valve (JC Medical) and the JenaValve (JenaValve Technology). Both devices have been used successfully via the transapical approach. The transfemoral experience is limited to first-in-human publications and to a clinical trial dedicated to AR, for which the completion date is still pending.

SUBMITTER: Costanzo P

PROVIDER: S-EPMC9340575 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Transcatheter Aortic Valve Implantation for Severe Pure Aortic Regurgitation With Dedicated Devices.

Costanzo Pierluigi P Bamborough Paul P Peterson Mark M Deva Djeven J DJ Ong Geraldine G Fam Neil N

Interventional cardiology (London, England) 20220101

Aortic regurgitation (AR) is not the most common valvular disease; however, its prevalence increases with age, with more than 2% of those aged >70 years having at least moderate AR. Once symptoms related to AR develop, the prognosis becomes poor. Transcatheter aortic valve implantation for patients with pure severe AR and at prohibitive surgical risk is occasionally performed, but remains a clinical challenge due to absence of valvular calcium, large aortic root and increased stroke volume. Thes ...[more]

PMID: 35923768

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Project description:BackgroundAccumulated experience and advances in device technology have led to the increasing off-label use of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation (PNAR). This study aimed to evaluate the procedural and long-term outcomes of using newer-generation transcatheter heart valves (THVs) versus early-generation self-expanding CoreValve (Medtronic, Minneapolis, USA) to treat PNAR.MethodsTAVRs were performed with the use of early- (N=15) and newer-generation (N=10) THVs in a total of 25 consecutive PNAR patients at an intermediate-to-high risk for surgical aortic valve replacement [mean Society of Thoracic Surgeons (STS) score of 6.8±4.5]. Procedural and clinical outcomes were reported according to the Valve Academic Research Consortium 2 criteria. The primary end-point of the study was all-cause mortality, myocardial infarction (MI), disabling stroke, and readmission due to heart failure.ResultsThe device success rate of the newer-generation THVs was significantly higher than that of the early-generation CoreValve (100% vs. 33%, P<0.01), which was mainly driven by less frequent need for implanting a second THV (0% vs. 53%, P<0.01). Although the procedural success rates were 100% for both early- and newer-generation valves, the mean procedure fluoroscopic times which the newer-generation device group required, were significantly shorter (P<0.01) and the amount of contrast medium used in this group, markedly smaller (P<0.01), compared to those of the early-generation CoreValve group. During a median follow-up of 14 months, event-free survival was better in patients undergoing TAVR with the newer-generation THVs, although the differences were not statistically significant (log-rank test, P=0.137). According to multivariate analysis, a higher baseline STS score and longer intensive care unit stays are independent predictors of adverse outcomes.ConclusionsEvidently, the treatment of PNAR with TAVR using the newer-generation THVs yielded better procedural outcomes and is a valuable therapeutic option in selective patients.KeywordsTranscatheter aortic valve replacement (TAVR); pure native aortic regurgitation (AR); transcatheter heart valves (THVs); procedural and clinical outcomes.

Dataset Information

Transcatheter Aortic Valve Implantation for Severe Pure Aortic Regurgitation With Dedicated Devices.

Publications

Transcatheter Aortic Valve Implantation for Severe Pure Aortic Regurgitation With Dedicated Devices.

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