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Background: For individuals with pure aortic regurgitation (AR), transcatheter aortic valve implantation (TAVI) is cautiously recommended only for those with a high or prohibitive surgical risk. We aimed to describe the results of a case series of transcatheter implantation of a balloon-expandable aortic valve bioprosthesis (BEV) for the treatment of noncalcified native valve AR. Methods: From February 2022-November 2022, we performed TAVI in patients with severe pure AR. Cases were indicated on the basis of symptoms, high/prohibitive surgical risk, or patient refusal of conventional treatment. Results: Five patients underwent successful TAVI. The mean age was 81.9 ± 6.6 years, 3 (60%) female and 5 (100%) in NYHA class III or IV. The baseline echocardiogram showed an ejection fraction of 49.0 ± 10.6% and left ventricular end-systolic diameter 28.5 ± 4.7â mm/m². The average area of the aortic annulus was 529.1 ± 47.0mm² and the area oversizing index was 17.6 ± 1.2%. In the 30-day follow-up, there were no cases of prosthesis embolization, annulus rupture, stroke, acute myocardial infarction, acute renal failure, hemorrhagic complication or death. One patient required a permanent pacemaker and another had a minor vascular complication. The clinical follow-up were 19.8 months (16.7-21.8). During this period, all patients remained alive and in NYHA class I or II. One of the patients developed a moderate paravalvular leak. Conclusion: TAVI with a BEV proved to be safe and effective in this small case series of patients with noncalcified native valve AR in a follow-up longer than 1 year.
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The PANTHEON (Performance of Currently Available traNscaTHEter Aortic Valve Platforms in Inoperable Patients With Pure Aortic regurgitatiON of a native valve) study examined transcatheter aortic valve replacement in patients with severe pure native aortic valve regurgitation. With a real-world dataset from 16 centres in Europe and the USA, the study encompassed 201 patients. The major complications included valve embolization or migration in 12.4%, moderate to severe aortic regurgitation in 9.5% cases and need for permanent pacemaker in 22.3% cases. Self-expanding and balloon-expandable devices demonstrated similar outcomes. Those experiencing valve embolization or migration had higher 1-year adverse event rates.
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This paper presents the first transcatheter management of severe aortic regurgitation in a 77-year-old woman with a criss-cross heart-an extremely rare and complex congenital heart disease. The procedure achieved an elimination of aortic regurgitation and resulted in a remarkable improvement of the patient's physical condition. (Level of Difficulty: Advanced.).
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Background: The rate of procedural success of transfemoral transcatheter aortic valve replacement (TAVR) with self-expanding valves in patients with pure native aortic regurgitation (PNAR) is quite low. Which anatomy evaluated by computed tomography (CT) as well as which kind of self-expanding valve is associated with higher success rate remain unknown. The aims of this study were to evaluate the relationship between preprocedural CT indexes and procedural success rate and to compare the procedural success rates between 2 kinds of self-expanding valves with different shaped frameworks. Methods: This was a retrospective comparative study. The study enrolled the symptomatic patients with severe PNAR, who were treated by transfemoral TAVR using a VenusA-Valve (Venus Medtech, Hangzhou, China) or a VitaFlow valve (Microport, Shanghai, China) at Zhongshan Hospital, Fudan University from October 2018 to December 2020. The procedural success rate (VARC-2 standard) was recorded. Preprocedural CT data were collected, including the perimeters of the aortic annulus (AA), left ventricular outflow tract (LVOT), sinotubular junction (STJ), and ascending aorta (AAO) and the angle of the aortic root. Leaflet thickening was evaluated qualitatively. Results: A total of 77 patients with a mean Society of Thoracic Surgeons (STS) score of 7.7±5.9 underwent TAVR. The total rate of procedural success was 80.5%. In the successful procedure group, the circumferences of the AA, LVOT, and STJ measured by CT were significant smaller than those in the failed procedure group (P=0.02, P=0.002 and P=0.045, respectively). Meanwhile, there were more patients with leaflet thickening in the successful procedure group (58.1% vs. 20.0%; P=0.02). The VenusA-Valve and the Vita-Flow valve were used in 47 patients and 30 patients, respectively. The procedural success rate was significantly higher in the VitaFlow group than in the VenusA-Valve group (93.3% vs. 72.3%; P=0.048), which was mainly due to the lower incidence of second transcatheter heart valves implantations in the VitaFlow group (6.7% vs. 27.7%; P=0.048). Conclusions: Severe PNAR patients with a smaller AA, LVOT, and STJ and leaflet thickening might have a higher success rate in transfemoral TAVR using a self-expanding valve. The self-expanding valve with a non-A-shaped framework might be a better choice for improved procedural outcomes.
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BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been validated for the treatment of severe symptomatic aortic stenosis in patients at high and intermediate surgical risk. Recently, TAVR has been proposed as an alternative to medical therapy in inoperable patients with severe native aortic valve regurgitation (NAVR). This multicenter international registry sought to evaluate safety and efficacy of TAVR with the self-expandable ACURATE neo valve in a cohort of patients with NAVR. METHODS: A total of 24 patients with severe NAVR treated by TAVR between September 2016 and October 2018 in 13 European centers were included. Clinical, procedural and follow up data were inserted in a dedicated database. Outcomes were codified according to Valve Academic Research Consortium-2 criteria. RESULTS: Mean age was 79.4 years, 58.4% were female. Mean EuroSCORE II and STS score were 5% and 3.9%, respectively. Device success was 87.5%. Moderate paravalvular leak (PVL) was found in two (8.3%) of patients, both with a perimeter oversizing index <10%. Implantation of a second device was necessary in three cases (12.5%), one for severe PVL and two for device displacement. New pacemaker implantation rate was 21.1%. At 30 days, stroke and all-cause mortality rates were 0% and 4.1%, respectively. CONCLUSIONS: This multicenter study suggests good feasibility and early safety of transfemoral TAVR with the self-expandable ACURATE neo device in patients with severe NAVR refused for surgery. Rates of moderate PVL, new pacemaker implantation and need for a second valve were higher than those reported for TAVR in aortic stenosis.
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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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@#Transcatheter aortic valve replacement (TAVR) has been confirmed to be safety and efficacy for high-risk elderly aortic stenosis, and the clinical effect of TAVR for medium and low-risk aortic stenosis is not worse than that of surgery. The development of surgical techniques and instruments has made cardiologists attempt to broaden the surgical indications. Many elderly and high-risk patients with pure native aortic regurgitation have been treated “off label” with similar techniques, completing artificial valve replacement, restoring valve function and improving the prognosis. However, due to the high requirements of surgical techniques and surgical complications, there is a lack of randomized controlled studies to confirm its safety and effectiveness. Unlike aortic stenosis, native aortic regurgitation presents unique challenges for transcatheter valves. In this article, the authors review current advances in the treatment of aortic valve regurgitation with TAVR.
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The use of balloon-expandable prosthesis in the treatment of native aortic valve regurgitation in the presence of ascending aortic dissection is described.