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Transcatheter Aortic Valve Implantation for Pure Severe Native Aortic Valve Regurgitation

Journal of the American College of Cardiology, 2013-04, Vol.61 (15), p.1577-1584 [Peer Reviewed Journal]

American College of Cardiology Foundation ;2013 American College of Cardiology Foundation ;2014 INIST-CNRS ;Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Apr 16, 2013 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2013.01.018 ;PMID: 23433565 ;CODEN: JACCDI

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Title:
Transcatheter Aortic Valve Implantation for Pure Severe Native Aortic Valve Regurgitation
Author: Roy, David A., MD ; Schaefer, Ulrich, MD, PhD ; Guetta, Victor, MD ; Hildick-Smith, David, MD ; Möllmann, Helge, MD ; Dumonteil, Nicholas, MD ; Modine, Thomas, MD ; Bosmans, Johan, MD ; Petronio, Anna Sonia, MD ; Moat, Neil, MBBS, MS ; Linke, Axel, MD ; Moris, Cesar, MD ; Champagnac, Didier, MD ; Parma, Radoslaw, MD, PhD ; Ochala, Andrzej, MD ; Medvedofsky, Diego, MD ; Patterson, Tiffany, MD ; Woitek, Felix, MD ; Jahangiri, Marjan, MD ; Laborde, Jean-Claude, MD ; Brecker, Stephen J., MD
Subjects: Aged ; Aged, 80 and over ; Aortic Valve - pathology ; Aortic Valve - physiopathology ; Aortic Valve - surgery ; Aortic Valve Insufficiency - diagnostic imaging ; Aortic Valve Insufficiency - physiopathology ; Aortic Valve Insufficiency - surgery ; Biological and medical sciences ; Calcification ; Calcinosis ; Cardiac Catheterization - methods ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Coronary vessels ; Echocardiography - methods ; Endocardial and cardiac valvular diseases ; Female ; Heart ; Heart attacks ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - methods ; Heart Valve Prosthesis Implantation - mortality ; Heart Valve Prosthesis Implantation - statistics & numerical data ; Humans ; Internal Medicine ; Intraoperative Care - methods ; Intraoperative Care - statistics & numerical data ; Laboratories ; Male ; Medical sciences ; Mortality ; native aortic valve regurgitation ; Patients ; Postoperative Complications - epidemiology ; Prostheses ; Prosthesis Design ; Pulmonary hypertension ; Radiation therapy ; Registries - statistics & numerical data ; Retrospective Studies ; Risk Adjustment ; Severity of Illness Index ; Sinuses ; Stroke ; Stroke - epidemiology ; Stroke - etiology ; Studies ; Surgery ; Survival Rate ; transcatheter aortic valve implantation
Is Part Of: Journal of the American College of Cardiology, 2013-04, Vol.61 (15), p.1577-1584
Description: Objectives This study sought to collect data and evaluate the anecdotal use of transcatheter aortic valve implantation (TAVI) in pure native aortic valve regurgitation (NAVR) for patients who were deemed surgically inoperable Background Data and experience with TAVI in the treatment of patients with pure severe NAVR are limited. Methods Data on baseline patient characteristics, device and procedure parameters, echocardiographic parameters, and outcomes up to July 2012 were collected retrospectively from 14 centers that have performed TAVI for NAVR. Results A total of 43 patients underwent TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, Minnesota) at 14 centers (mean age, 75.3 ± 8.8 years; 53% female; mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation), 26.9 ± 17.9%; and mean Society of Thoracic Surgeons score, 10.2 ± 5.3%). All patients had severe NAVR on echocardiography without aortic stenosis and 17 patients (39.5%) had the degree of aortic valvular calcification documented on CT or echocardiography. Vascular access was transfemoral (n = 35), subclavian (n = 4), direct aortic (n = 3), and carotid (n = 1). Implantation of a TAVI was performed in 42 patients (97.7%), and 8 patients (18.6%) required a second valve during the index procedure for residual aortic regurgitation. In all patients requiring second valves, valvular calcification was absent (p = 0.014). Post-procedure aortic regurgitation grade I or lower was present in 34 patients (79.1%). At 30 days, the major stroke incidence was 4.7%, and the all-cause mortality rate was 9.3%. At 12 months, the all-cause mortality rate was 21.4% (6 of 28 patients). Conclusions This registry analysis demonstrates the feasibility and potential procedure difficulties when using TAVI for severe NAVR. Acceptable results may be achieved in carefully selected patients who are deemed too high risk for conventional surgery, but the possibility of requiring 2 valves and leaving residual aortic regurgitation remain important considerations.
Publisher: New York, NY: Elsevier Inc
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2013.01.018
PMID: 23433565
CODEN: JACCDI
Source: Geneva Foundation Free Medical Journals at publisher websites
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Transcatheter Aortic Valve Implantation for Pure Severe Native Aortic Valve Regurgitation

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