Advances in transcatheter aortic valve replacement for pure native aortic regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Lulu , SHI Jun , QIAN Hong ,  GUO Yingqiang

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

GUO Yingqiang, Email: drguoyq@hotmail.com

Keywords：

Native aortic valve regurgitation; valve; transcatheter aortic valve replacement

DOI：

10.7507/1007-4848.201904048

Video：

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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.

Citation： LIU Lulu, SHI Jun, QIAN Hong, GUO Yingqiang. Advances in transcatheter aortic valve replacement for pure native aortic regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1266-1270. doi: 10.7507/1007-4848.201904048 Copy

1.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis. Circulation, 2002, 106(24): 3006-3008.
2.	Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. The Lancet, 2015, 385(9986): 2477-2484.
3.	Carabello BA. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. Curr Cardiol Rep, 2011, 13(3): 173-174.
4.	Deeb GM, Reardon MJ, Chetcuti S, et al. 3-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J Am Coll Cardiol, 2016, 67(22): 2565-2574.
5.	Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol, 2014, 63(19): 1972-1981.
6.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
7.	Yancy CW, Januzzi JL, Jr, Allen LA, et al. 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: A report of the American College of Cardiology task force on expert consensus decision pathways. J Am Coll Cardiol, 2018, 71(2): 201-230.
8.	Roy DA, Schaefer U, Guetta V, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. J Am Coll Cardiol, 2013, 61(15): 1577-1584.
9.	Belardi J, Lamelas P. TAVR for aortic valve regurgitation: Ready for a randomized trial? Catheter Cardiovasc Interv, 2019, 93(2): 354-355.
10.	Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
11.	Pesarini G, Lunardi M, Piccoli A, et al. Effectiveness and safety of transcatheter aortic valve implantation in patients with pure aortic regurgitation and advanced heart failure. Am J Cardiol, 2018, 121(5): 642-648.
12.	Rawasia WF, Khan MS, Usman MS, et al. Safety and efficacy of transcatheter aortic valve replacement for native aortic valve regurgitation: A systematic review and meta-analysis. Catheter Cardiovasc Interv, 2019, 93(2): 345-353.
13.	Akinseye OA, Pathak A, Ibebuogu UN. Aortic valve regurgitation: A comprehensive review. Curr Probl Cardiol, 2018, 43(8): 315-334.
14.	Siegel RJ, Luo H, Makar M, et al. Optimal use of echocardiography in valvular heart disease evaluation. Heart, 2015, 101(12): 977-986.
15.	Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation, 2005, 112(1): 125-134.
16.	Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2009, 22(9): 975-1014.
17.	Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol, 1999, 83(6): 897-902.
18.	Pan W, Zhou D, Cheng L, et al. Aortic regurgitation is more prevalent than aortic stenosis in Chinese elderly population: Implications for transcatheter aortic valve replacement. Int J Cardiol, 2015, 201: 547-548.
19.	Bonow RO, Lakatos E, Maron BJ, et al. Serial long-term assessment of the natural history of asymptomatic patients with chronic aortic regurgitation and normal left ventricular systolic function. Circulation, 1991, 84(4): 1625-1635.
20.	Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation, 1999, 99(14): 1851-1857.
21.	Tornos P, Sambola A, Permanyer-Miralda G, et al. Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgery. J Am Coll Cardiol, 2006, 47(5): 1012-1017.
22.	Bonow RO. Chronic mitral regurgitation and aortic regurgitation: have indications for surgery changed? J Am Coll Cardiol, 2013, 61(7): 693-701.
23.	Babaliaros V, Cribier A. The expansion of transcatheter technology to treat aortic insufficiency: everything old becomes new again. JACC Cardiovasc Interv, 2014, 7(10): 1175-1176.
24.	Roy D, Sharma R, Brecker SJ. Native aortic valve regurgitation: transcatheter therapeutic options. EuroIntervention, 2013, 9(Suppl): S55-62.
25.	Schlingloff F, Schafer U, Frerker C, et al. Transcatheter aortic valve implantation of a second-generation valve for pure aortic regurgitation: procedural outcome, haemodynamic data and follow-up. Interact Cardiovasc Thorac Surg, 2014, 19(3): 388-393.
26.	Bleiziffer S, Mazzitelli D, Nobauer C, et al. Successful treatment of pure aortic insufficiency with transapical implantation of the JenaValve. Thorac Cardiovasc Surg, 2013, 61(5): 428-430.
27.	Zhu D, Wei L, Cheung A, et al. Treatment of pure aortic regurgitation using a second-generation transcatheter aortic valve implantation system. J Am Coll Cardiol, 2016, 67(23): 2803-2805.
28.	Zhu D, Chen Y, Guo Y, et al. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system - J-valve for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up. Int J Cardiol, 2015, 199: 155-162.
29.	Urena M, Himbert D, Ohlmann P, et al. Transcatheter aortic valve replacement to treat pure aortic regurgitation on noncalcified native valves. J Am Coll Cardiol, 2016, 68(15): 1705-1706.
30.	Haddad A, Arwani R, Altayar O, et al. Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation: A systematic review and meta-analysis. Clin Cardiol, 2019, 42(1): 159-166.
31.	Spina R, Anthony C, Muller DW, et al. Transcatheter aortic valve replacement for native aortic valve regurgitation. Interv Cardiol, 2015, 10(1): 49-54.
32.	De Backer O, Pilgrim T, Simonato M, et al. Usefulness of transcatheter aortic valve implantation for treatment of pure native aortic valve regurgitation. Am J Cardiol, 2018, 122(6): 1028-1035.
33.	Sawaya FJ, Deutsch MA, Seiffert M, et al. Safety and efficacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses: results from an international registry study. JACC Cardiovasc Interv, 2017, 10(10): 1048-1056.
34.	Testa L, Latib A, Rossi ML, et al. CoreValve implantation for severe aortic regurgitation: a multicentre registry. EuroIntervention, 2014, 10(6): 739-745.
35.	Kappetein AP, Head SJ, Genereux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J, 2012, 33(19): 2403-2418.

1. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis. Circulation, 2002, 106(24): 3006-3008.
2. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. The Lancet, 2015, 385(9986): 2477-2484.
3. Carabello BA. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. Curr Cardiol Rep, 2011, 13(3): 173-174.
4. Deeb GM, Reardon MJ, Chetcuti S, et al. 3-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J Am Coll Cardiol, 2016, 67(22): 2565-2574.
5. Popma JJ, Adams DH, Reardon MJ, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol, 2014, 63(19): 1972-1981.
6. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
7. Yancy CW, Januzzi JL, Jr, Allen LA, et al. 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: A report of the American College of Cardiology task force on expert consensus decision pathways. J Am Coll Cardiol, 2018, 71(2): 201-230.
8. Roy DA, Schaefer U, Guetta V, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. J Am Coll Cardiol, 2013, 61(15): 1577-1584.
9. Belardi J, Lamelas P. TAVR for aortic valve regurgitation: Ready for a randomized trial? Catheter Cardiovasc Interv, 2019, 93(2): 354-355.
10. Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
11. Pesarini G, Lunardi M, Piccoli A, et al. Effectiveness and safety of transcatheter aortic valve implantation in patients with pure aortic regurgitation and advanced heart failure. Am J Cardiol, 2018, 121(5): 642-648.
12. Rawasia WF, Khan MS, Usman MS, et al. Safety and efficacy of transcatheter aortic valve replacement for native aortic valve regurgitation: A systematic review and meta-analysis. Catheter Cardiovasc Interv, 2019, 93(2): 345-353.
13. Akinseye OA, Pathak A, Ibebuogu UN. Aortic valve regurgitation: A comprehensive review. Curr Probl Cardiol, 2018, 43(8): 315-334.
14. Siegel RJ, Luo H, Makar M, et al. Optimal use of echocardiography in valvular heart disease evaluation. Heart, 2015, 101(12): 977-986.
15. Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation, 2005, 112(1): 125-134.
16. Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2009, 22(9): 975-1014.
17. Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol, 1999, 83(6): 897-902.
18. Pan W, Zhou D, Cheng L, et al. Aortic regurgitation is more prevalent than aortic stenosis in Chinese elderly population: Implications for transcatheter aortic valve replacement. Int J Cardiol, 2015, 201: 547-548.
19. Bonow RO, Lakatos E, Maron BJ, et al. Serial long-term assessment of the natural history of asymptomatic patients with chronic aortic regurgitation and normal left ventricular systolic function. Circulation, 1991, 84(4): 1625-1635.
20. Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation, 1999, 99(14): 1851-1857.
21. Tornos P, Sambola A, Permanyer-Miralda G, et al. Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgery. J Am Coll Cardiol, 2006, 47(5): 1012-1017.
22. Bonow RO. Chronic mitral regurgitation and aortic regurgitation: have indications for surgery changed? J Am Coll Cardiol, 2013, 61(7): 693-701.
23. Babaliaros V, Cribier A. The expansion of transcatheter technology to treat aortic insufficiency: everything old becomes new again. JACC Cardiovasc Interv, 2014, 7(10): 1175-1176.
24. Roy D, Sharma R, Brecker SJ. Native aortic valve regurgitation: transcatheter therapeutic options. EuroIntervention, 2013, 9(Suppl): S55-62.
25. Schlingloff F, Schafer U, Frerker C, et al. Transcatheter aortic valve implantation of a second-generation valve for pure aortic regurgitation: procedural outcome, haemodynamic data and follow-up. Interact Cardiovasc Thorac Surg, 2014, 19(3): 388-393.
26. Bleiziffer S, Mazzitelli D, Nobauer C, et al. Successful treatment of pure aortic insufficiency with transapical implantation of the JenaValve. Thorac Cardiovasc Surg, 2013, 61(5): 428-430.
27. Zhu D, Wei L, Cheung A, et al. Treatment of pure aortic regurgitation using a second-generation transcatheter aortic valve implantation system. J Am Coll Cardiol, 2016, 67(23): 2803-2805.
28. Zhu D, Chen Y, Guo Y, et al. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system - J-valve for high-risk patients with aortic valve diseases: Initial results with 90-day follow-up. Int J Cardiol, 2015, 199: 155-162.
29. Urena M, Himbert D, Ohlmann P, et al. Transcatheter aortic valve replacement to treat pure aortic regurgitation on noncalcified native valves. J Am Coll Cardiol, 2016, 68(15): 1705-1706.
30. Haddad A, Arwani R, Altayar O, et al. Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation: A systematic review and meta-analysis. Clin Cardiol, 2019, 42(1): 159-166.
31. Spina R, Anthony C, Muller DW, et al. Transcatheter aortic valve replacement for native aortic valve regurgitation. Interv Cardiol, 2015, 10(1): 49-54.
32. De Backer O, Pilgrim T, Simonato M, et al. Usefulness of transcatheter aortic valve implantation for treatment of pure native aortic valve regurgitation. Am J Cardiol, 2018, 122(6): 1028-1035.
33. Sawaya FJ, Deutsch MA, Seiffert M, et al. Safety and efficacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses: results from an international registry study. JACC Cardiovasc Interv, 2017, 10(10): 1048-1056.
34. Testa L, Latib A, Rossi ML, et al. CoreValve implantation for severe aortic regurgitation: a multicentre registry. EuroIntervention, 2014, 10(6): 739-745.
35. Kappetein AP, Head SJ, Genereux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J, 2012, 33(19): 2403-2418.

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