Outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation with the use of newer- vs. early-generation devices

Wei-Hsian Yin; Yung-Tsai Lee; Tien-Ping Tsao; Kuo-Chen Lee; Ming-Chon Hsiung; Jeng Wei

doi:10.21037/atm-21-6936

Outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation with the use of newer- vs. early-generation devices

Ann Transl Med. 2022 Jan;10(1):24. doi: 10.21037/atm-21-6936.

Authors

Wei-Hsian Yin^{1

2}, Yung-Tsai Lee^{1

3}, Tien-Ping Tsao^{1

4}, Kuo-Chen Lee^{1

4}, Ming-Chon Hsiung¹, Jeng Wei^{1

4}

Affiliations

¹ Heart Center, Cheng Hsin General Hospital, Taipei.
² Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei.
³ Institute of Microbiology and Immunology, School of Medicine, National Yang Ming Chiao Tung University, Taipei.
⁴ Faculty of Medicine, National Defense Medical Center, Taipei.

Abstract

Background: Accumulated experience and advances in device technology have led to the increasing off-label use of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation (PNAR). This study aimed to evaluate the procedural and long-term outcomes of using newer-generation transcatheter heart valves (THVs) versus early-generation self-expanding CoreValve (Medtronic, Minneapolis, USA) to treat PNAR.

Methods: TAVRs were performed with the use of early- (N=15) and newer-generation (N=10) THVs in a total of 25 consecutive PNAR patients at an intermediate-to-high risk for surgical aortic valve replacement [mean Society of Thoracic Surgeons (STS) score of 6.8±4.5]. Procedural and clinical outcomes were reported according to the Valve Academic Research Consortium 2 criteria. The primary end-point of the study was all-cause mortality, myocardial infarction (MI), disabling stroke, and readmission due to heart failure.

Results: The device success rate of the newer-generation THVs was significantly higher than that of the early-generation CoreValve (100% vs. 33%, P<0.01), which was mainly driven by less frequent need for implanting a second THV (0% vs. 53%, P<0.01). Although the procedural success rates were 100% for both early- and newer-generation valves, the mean procedure fluoroscopic times which the newer-generation device group required, were significantly shorter (P<0.01) and the amount of contrast medium used in this group, markedly smaller (P<0.01), compared to those of the early-generation CoreValve group. During a median follow-up of 14 months, event-free survival was better in patients undergoing TAVR with the newer-generation THVs, although the differences were not statistically significant (log-rank test, P=0.137). According to multivariate analysis, a higher baseline STS score and longer intensive care unit stays are independent predictors of adverse outcomes.

Conclusions: Evidently, the treatment of PNAR with TAVR using the newer-generation THVs yielded better procedural outcomes and is a valuable therapeutic option in selective patients.

Keywords: Transcatheter aortic valve replacement (TAVR); pure native aortic regurgitation (AR); transcatheter heart valves (THVs); procedural and clinical outcomes.