Transcatheter Aortic Valve Implantation for Pure Severe Native Aortic Valve Regurgitation

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• 作者：David A. Roy ; MD^? ; ^{deproy@hotmail.com} ; Ulrich Schaefer ; MD ; PhD^&dagger ; ; Victor Guetta ; MD^&Dagger ; ; David Hildick-Smith ; MD^§ ; ; Helge Mö ; llmann ; MD^¡Î ; Nicholas Dumonteil ; MD^¶ ; ; Thomas Modine ; MD^# ; Johan Bosmans ; MD^?? ; Anna Sonia Petronio ; MD^&dagger ; &dagger ; ; Neil Moat ; MBBS ; MS^&Dagger ; &Dagger ; ; Axel Linke ; MD^§ ; § ; ; Cesar Moris ; MD^¡Î¡Î ; Didier Champagnac ; MD^¶ ; ¶ ; ; Radoslaw Parma ; MD ; PhD^## ; Andrzej Ochala ; MD^## ; Diego Medvedofsky ; MD^&Dagger ; ; Tiffany Patterson ; MD^&Dagger ; &Dagger ; ; Felix Woitek ; MD^§ ; § ; ; Marjan Jahangiri ; MD^? ; Jean-Claude Laborde ; MD^? ; Stephen J. Brecker ; MD^?
• 关键词：native aortic valve regurgitation ; transcatheter aortic valve implantation
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：16 April, 2013
• 年：2013
• 卷：61
• 期：15
• 页码：1577-1584
• 全文大小：2070 K

文摘

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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 ¡À 8.8 years; 53 % female; mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation), 26.9 ¡À 17.9 % ; and mean Society of Thoracic Surgeons score, 10.2 ¡À 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.