Author/Authors :
Roy، نويسنده , , David A. and Schaefer، نويسنده , , Ulrich and Guetta، نويسنده , , Victor and Hildick-Smith، نويسنده , , David and Mِllmann، نويسنده , , Helge and Dumonteil، نويسنده , , Nicholas and Modine، نويسنده , , Thomas and Bosmans، نويسنده , , Johan and Petronio، نويسنده , , Anna Sonia and Moat، نويسنده , , Neil and Linke، نويسنده , , Axel and Moris، نويسنده , , Cesar and Champagnac، نويسنده , , Didier and Parma، نويسنده , , Radoslaw and Ochala، نويسنده , , Andrzej and Medvedofsky، نويسنده , , Diego and Patterson، نويسنده , , Tiffany and Woitek، نويسنده , , Felix and Jahangiri، نويسنده , , Marjan and Laborde، نويسنده , , Jean-Claude and Brecker، نويسنده , , Stephen J.، نويسنده ,
Abstract :
Objectives
tudy 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
ound
nd experience with TAVI in the treatment of patients with pure severe NAVR are limited.
s
n 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.
s
l 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).
sions
egistry 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.
