Outcomes and preoperative evaluation of transfemoral transcatheter aortic valve replacement (TAVR) in the treatment of pure native aortic valve regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Donghui , LUO Xinjin , WANG Xu , WANG Yuetang , FENG Xiang , LI Xuanshu , QIU Juntao ,  WANG Wei

Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

WANG Wei, Email: drweiwangfuwai@163.com

Keywords：

Aortic valve regurgitation; aortic root morphology; transcatheter aortic valve replacement; minimally invasive surgery

DOI：

10.7507/1007-4848.202101094

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation.Methods A total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients).Results The incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group.Conclusion Transfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.

Citation： XU Donghui, LUO Xinjin, WANG Xu, WANG Yuetang, FENG Xiang, LI Xuanshu, QIU Juntao, WANG Wei. Outcomes and preoperative evaluation of transfemoral transcatheter aortic valve replacement (TAVR) in the treatment of pure native aortic valve regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1054-1060. doi: 10.7507/1007-4848.202101094 Copy

1.	Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
2.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
3.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
4.	Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
5.	Writing Committee Members, Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): 450-500.
6.	Testa L, Latib A, Rossi ML, et al. CoreValve implantation for severe aortic regurgitation: A multicentre registry. EuroIntervention, 2014, 10(6): 739-745.
7.	Roy D, Sharma R, Brecker SJ. Native aortic valve regurgitation: Transcatheter therapeutic options. EuroIntervention, 2013, 9(Suppl): S55-S62.
8.	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.
9.	中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识(2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
10.	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.
11.	Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J, 2003, 24(13): 1231-1243.
12.	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.
13.	Jiang J, Liu X, He Y, et al. Transcatheter aortic valve replacement for pure native aortic valve regurgitation: A systematic review. Cardiology, 2018, 141(3): 132-140.
14.	Barbanti M, Yang TH, Rodès Cabau J, et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation, 2013, 128(3): 244-253.
15.	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.
16.	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.
17.	Hansen JW, Foy A, Yadav P, et al. Death and dialysis after transcatheter aortic valve replacement: An analysis of the STS/ACC TVT registry. JACC Cardiovasc Interv, 2017, 10(20): 2064-2075.
18.	Romano M, Frank D, Cocchieri R, et al. Transaortic transcatheter aortic valve implantation using SAPIEN XT or SAPIEN 3 valves in the ROUTE registry. Interact Cardiovasc Thorac Surg, 2017, 25(5): 757-764.
19.	Anwaruddin S, Desai ND, Szeto WY, et al. Self-expanding valve system for treatment of native aortic regurgitation by transcatheter aortic valve implantation (from the STS/ACC TVT registry). Am J Cardiol, 2019, 124(5): 781-788.
20.	Takagi H, Hari Y, Kawai N, et al. Meta-analysis and meta-regression of transcatheter aortic valve implantation for pure native aortic regurgitation. Heart Lung Circ, 2020, 29(5): 729-741.
21.	Schofer J, Nietlispach F, Bijuklic K, et al. Transfemoral implantation of a fully repositionable and retrievable transcatheter valve for noncalcified pure aortic regurgitation. JACC Cardiovasc Interv, 2015, 8(14): 1842-1849.
22.	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.
23.	Seiffert M, Bader R, Kappert U, et al. Initial German experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv, 2014, 7(10): 1168-1174.

1. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
2. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
3. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
4. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
5. Writing Committee Members, Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): 450-500.
6. Testa L, Latib A, Rossi ML, et al. CoreValve implantation for severe aortic regurgitation: A multicentre registry. EuroIntervention, 2014, 10(6): 739-745.
7. Roy D, Sharma R, Brecker SJ. Native aortic valve regurgitation: Transcatheter therapeutic options. EuroIntervention, 2013, 9(Suppl): S55-S62.
8. 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.
9. 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识(2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
10. 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.
11. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J, 2003, 24(13): 1231-1243.
12. 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.
13. Jiang J, Liu X, He Y, et al. Transcatheter aortic valve replacement for pure native aortic valve regurgitation: A systematic review. Cardiology, 2018, 141(3): 132-140.
14. Barbanti M, Yang TH, Rodès Cabau J, et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation, 2013, 128(3): 244-253.
15. 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.
16. 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.
17. Hansen JW, Foy A, Yadav P, et al. Death and dialysis after transcatheter aortic valve replacement: An analysis of the STS/ACC TVT registry. JACC Cardiovasc Interv, 2017, 10(20): 2064-2075.
18. Romano M, Frank D, Cocchieri R, et al. Transaortic transcatheter aortic valve implantation using SAPIEN XT or SAPIEN 3 valves in the ROUTE registry. Interact Cardiovasc Thorac Surg, 2017, 25(5): 757-764.
19. Anwaruddin S, Desai ND, Szeto WY, et al. Self-expanding valve system for treatment of native aortic regurgitation by transcatheter aortic valve implantation (from the STS/ACC TVT registry). Am J Cardiol, 2019, 124(5): 781-788.
20. Takagi H, Hari Y, Kawai N, et al. Meta-analysis and meta-regression of transcatheter aortic valve implantation for pure native aortic regurgitation. Heart Lung Circ, 2020, 29(5): 729-741.
21. Schofer J, Nietlispach F, Bijuklic K, et al. Transfemoral implantation of a fully repositionable and retrievable transcatheter valve for noncalcified pure aortic regurgitation. JACC Cardiovasc Interv, 2015, 8(14): 1842-1849.
22. 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.
23. Seiffert M, Bader R, Kappert U, et al. Initial German experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv, 2014, 7(10): 1168-1174.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Outcomes and preoperative evaluation of transfemoral transcatheter aortic valve replacement (TAVR) in the treatment of pure native aortic valve regurgitation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content