TAVR for Aortic Regurgitation: Proceed with Caution

According to a small, international study, the procedure can be successful in carefully selected patients with regurgitation but no stenosis who are ineligible for surgery.

Transcatheter aortic valve replacement (TAVR) is approved in the U.S. for treatment of aortic stenosis in patients who are ineligible for surgery or at high surgical risk. However, outside the U.S., TAVR is being used for a number of other conditions. In this study from 14 centers in Europe and Israel, investigators examined procedural success and outcomes with the self-expanding CoreValve device in 43 patients (mean age, 75 years; 53% women) with severe, native aortic regurgitation (AR) without aortic stenosis. All were considered unsuitable for open surgery because of comorbidities (mean Society of Thoracic Surgeons score, 10.2%).

Devices were successfully implanted in 98% of patients, 8 of whom required a second valve for residual AR (19%). One patient required conversion to surgery for severe residual AR. In the remaining patients, postprocedural AR grade was 

≤I in 79%, II in 16%, and III in 5%. At 30 days, all-cause mortality was 9%, and 2 patients had major strokes (5%). At 1 year, all-cause mortality was 21%.

Comment: This study demonstrates the feasibility of transcatheter aortic valve replacement with the CoreValve device for pure, severe native aortic regurgitation. Challenges to successful TAVR in this patient group include lack of calcification for positioning and fixation, large annulus, and relatively diverse and variable anatomy. The high mortality, frequent need for a second valve, and residual AR in this study will — for the time being — probably limit this therapy to patients with extremely high surgical risk.

Source: Journal Watch Cardiology



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