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Usefulness of Transcatheter Aortic Valve Implantation for Treatment of Pure Native Aortic Valve Regurgitation

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  • Ole De Backer
  • Thomas Pilgrim
  • Matheus Simonato
  • G Burkhard Mackensen
  • Claudia Fiorina
  • Verena Veulemanns
  • Alfredo Cerillo
  • Joachim Schofer
  • Nicolas Amabile
  • Guy Achkouty
  • Ulrich Schäfer
  • Marcus-André Deutsch
  • Jan-Malte Sinning
  • Mohammed S Rahman
  • Fadi J Sawaya
  • David Hildick-Smith
  • Jose Maria Hernandez
  • Won-Keun Kim
  • Thierry Lefevre
  • Moritz Seiffert
  • Sabine Bleiziffer
  • Anna Sonia Petronio
  • Nicolas Van Mieghem
  • Maurizio Taramasso
  • Lars Søndergaard
  • Stephan Windecker
  • Azeem Latib
  • Danny Dvir
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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.

Original languageEnglish
JournalThe American journal of cardiology
Volume122
Issue number6
Pages (from-to)1028-1035
Number of pages8
ISSN0002-9149
DOIs
Publication statusPublished - 15 Sep 2018

ID: 56519824