TY - JOUR
T1 - Usefulness of Transcatheter Aortic Valve Implantation for Treatment of Pure Native Aortic Valve Regurgitation
AU - De Backer, Ole
AU - Pilgrim, Thomas
AU - Simonato, Matheus
AU - Mackensen, G. Burkhard
AU - Fiorina, Claudia
AU - Veulemanns, Verena
AU - Cerillo, Alfredo
AU - Schofer, Joachim
AU - Amabile, Nicolas
AU - Achkouty, Guy
AU - Schäfer, Ulrich
AU - Deutsch, Marcus André
AU - Sinning, Jan Malte
AU - Rahman, Mohammed S.
AU - Sawaya, Fadi J.
AU - Hildick-Smith, David
AU - Hernandez, Jose Maria
AU - Kim, Won Keun
AU - Lefevre, Thierry
AU - Seiffert, Moritz
AU - Bleiziffer, Sabine
AU - Petronio, Anna Sonia
AU - Van Mieghem, Nicolas
AU - Taramasso, Maurizio
AU - Søndergaard, Lars
AU - Windecker, Stephan
AU - Latib, Azeem
AU - Dvir, Danny
N1 - Publisher Copyright:
© 2018
PY - 2018/9/15
Y1 - 2018/9/15
N2 - Patients with pure native aortic valve regurgitation (NAVR) and increased surgical risk are often denied surgery. This retrospective study aimed to evaluate the “off-label” use of transcatheter heart valves (THV) for the treatment of NAVR. A total of 254 high surgical risk patients with NAVR (age 74 ± 12 years, Society of Thoracic Surgeons risk score 6.6 ± 6.2%) underwent transcatheter aortic valve implantation (TAVI) with early generation (43%) or newer generation (57%) devices at 46 different sites. Device success was significantly higher in patients treated with newer as compared with early generation THV (82% vs 47%, p <0.001). The difference was driven by lower rates of device malpositioning (9% vs 33%) and aortic regurgitation (AR) ≥ moderate (4% vs 31%) and translated into higher clinical efficacy at 30 days in patients treated with newer as compared with early generation THV (72% vs 56%, p = 0.041). Both THV under- and oversizing were associated with an increased risk of THV malpositioning. In conclusion, TAVI is a feasible treatment strategy in selected high-risk patients with NAVR but is associated with a considerable risk of THV malpositioning and residual AR. Although newer-generation THV are associated with better outcomes, novel devices for the treatment of NAVR are warranted.
AB - Patients with pure native aortic valve regurgitation (NAVR) and increased surgical risk are often denied surgery. This retrospective study aimed to evaluate the “off-label” use of transcatheter heart valves (THV) for the treatment of NAVR. A total of 254 high surgical risk patients with NAVR (age 74 ± 12 years, Society of Thoracic Surgeons risk score 6.6 ± 6.2%) underwent transcatheter aortic valve implantation (TAVI) with early generation (43%) or newer generation (57%) devices at 46 different sites. Device success was significantly higher in patients treated with newer as compared with early generation THV (82% vs 47%, p <0.001). The difference was driven by lower rates of device malpositioning (9% vs 33%) and aortic regurgitation (AR) ≥ moderate (4% vs 31%) and translated into higher clinical efficacy at 30 days in patients treated with newer as compared with early generation THV (72% vs 56%, p = 0.041). Both THV under- and oversizing were associated with an increased risk of THV malpositioning. In conclusion, TAVI is a feasible treatment strategy in selected high-risk patients with NAVR but is associated with a considerable risk of THV malpositioning and residual AR. Although newer-generation THV are associated with better outcomes, novel devices for the treatment of NAVR are warranted.
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U2 - 10.1016/j.amjcard.2018.05.044
DO - 10.1016/j.amjcard.2018.05.044
M3 - Article
C2 - 30072124
AN - SCOPUS:85050701267
SN - 0002-9149
VL - 122
SP - 1028
EP - 1035
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 6
ER -