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

Authors：

LI Qiao ,  CHEN Mao ,  FENG Yuan

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

Corresponding author：

CHEN Mao, Email: hmaochen@vip.sina.com; FENG Yuan, Email: fynotebook@hotmail.com

Keywords：

Pure aortic valve regurgitation; transcatheter heart valve; transcatheter aortic valve replacement; review

DOI：

10.7507/1007-4848.202106101

Video：

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Transcatheter aortic valve replacement (TAVR) for aortic stenosis has been confirmed to be safe and efficient, and its status has gradually increased with the continuous updating of guidelines. But for severe pure aortic valve regurgitation, it has long been considered a relative contraindication to TAVR. However, many elderly, high-risk patients with pure aortic regurgitation have also been treated with TAVR and prognosis was improved through off-label use of transcatheter heart valves due to contraindications to surgery or intolerance. But because of the complexity and challenging anatomic features, high technical requirements, limited device success rate, high rate of complications, and lack of randomized controlled studies to confirm its safety and efficacy, TAVR treatment of pure aortic regurgitation has been evolving in a debate. In recent years, with the application of new-generation valves and an increasing number of studies, some new insights have been gained regarding TAVR for severe aortic regurgitation, and this article will review the progress of research on TAVR for severe pure aortic regurgitation.

Citation： LI Qiao, CHEN Mao, FENG Yuan. Advances in transcatheter aortic valve replacement for pure aortic regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 651-657. doi: 10.7507/1007-4848.202106101 Copy

1.	Supino PG, Borer JS, Preibisz J, et al. The epidemiology of valvular heart disease: A growing public health problem. Heart Fail Clin, 2006, 2(4): 379-393.
2.	Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
3.	Goldbarg SH, Halperin JL. Aortic regurgitation: Disease progression and management. Nat Clin Pract Cardiovasc Med, 2008, 5(5): 269-279.
4.	Flint N, Wunderlich NC, Shmueli H, et al. Aortic regurgitation. Curr Cardiol Rep, 2019, 21(7): 65.
5.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
6.	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.
7.	Tarantini G, Fabris T. Pure aortic valve regurgitation: SAVR is the gold standard, but TAVR is another gun. Catheter Cardiovasc Interv, 2020, 95(4): 817-818.
8.	Chandola R, Cusimano R, Osten M, et al. Postcardiac transplant transcatheter core valve implantation for aortic insufficiency secondary to Impella device placement. Ann Thorac Surg, 2012, 93(6): e155-e157.
9.	Ducrocq G, Himbert D, Hvass U, et al. Compassionate aortic valve implantation for severe aortic regurgitation. J Thorac Cardiovasc Surg, 2010, 140(4): 930-932.
10.	Dumonteil N, Marcheix B, Lairez O, et al. Transcatheter aortic valve implantation for severe, non-calcified aortic regurgitation and narrow aortic root: Description from a case report of a new approach to potentially avoid coronary artery obstruction. Catheter Cardiovasc Interv, 2013, 82(2): E124-E127.
11.	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.
12.	Markham R, Ghodsian M, Sharma R. TAVR in patients with pure aortic regurgitation: Ready to use? Curr Cardiol Rep, 2020, 22(9): 98.
13.	Rotman OM, Bianchi M, Ghosh RP, et al. Principles of TAVR valve design, modelling, and testing. Expert Rev Med Devices, 2018, 15(11): 771-791.
14.	Tzamtzis S, Viquerat J, Yap J, et al. Numerical analysis of the radial force produced by the Medtronic-CoreValve and Edwards-SAPIEN after transcatheter aortic valve implantation (TAVI). Med Eng Phys, 2013, 35(1): 125-130.
15.	Möllmann H, Hengstenberg C, Hilker M, et al. Real-world experience using the ACURATE neo prosthesis: 30-day outcomes of 1, 000 patients enrolled in the SAVI TF registry. EuroIntervention, 2018, 13(15): e1764-e1770.
16.	Reardon MJ, Feldman TE, Meduri CU, et al. Two-year outcomes after transcatheter aortic valve replacement with mechanical vs. self-expanding valves: The REPRISE Ⅲ randomized clinical trial. JAMA Cardiol, 2019, 4(3): 223-229.
17.	Seiffert M, Diemert P, Koschyk D, et al. Transapical implantation of a second-generation transcatheter heart valve in patients with noncalcified aortic regurgitation. JACC Cardiovasc Interv, 2013, 6(6): 590-597.
18.	Wei L, Liu H, Zhu L, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-Valve and early outcome. JACC Cardiovasc Interv, 2015, 8(14): 1831-1841.
19.	Sündermann SH, Grünenfelder J, Corti R, et al. Feasibility of the Engager™ aortic transcatheter valve system using a flexible over-the-wire design. Eur J Cardiothorac Surg, 2012, 42(4): e48-e52.
20.	Wernly B, Eder S, Navarese EP, et al. Transcatheter aortic valve replacement for pure aortic valve regurgitation: "on-label" versus "off-label" use of TAVR devices. Clin Res Cardiol, 2019, 108(8): 921-930.
21.	Stachon P, Kaier K, Heidt T, et al. Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008-2015. Catheter Cardiovasc Interv, 2020, 95(4): 810-816.
22.	Arora S, Lahewala S, Zuzek Z, et al. Transcatheter aortic valve replacement in aortic regurgitation: The U. S. experience. Catheter Cardiovasc Interv, 2021, 98(1): E153-E162.
23.	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.
24.	Pellikka PA, Dangas G. TAVR for severe aortic regurgitation: Advancing the frontier. J Am Coll Cardiol, 2017, 70(22): 2764-2765.
25.	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.
26.	Gafoor S, Sharma R. TAVR for pure native aortic regurgitation and failing regurgitant surgical bioprostheses: Alternative indication or alternative fact? JACC Cardiovasc Interv, 2017, 10(10): 1057-1059.
27.	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.
28.	Liu L, Zhang J, Peng Y, et al. Learning curve for transcatheter aortic valve replacement for native aortic regurgitation: Safety and technical performance study. Clin Cardiol, 2020, 43(5): 475-482.
29.	Hensey M, Murdoch DJ, Sathananthan J, et al. First-in-human experience of a new-generation transfemoral transcatheter aortic valve for the treatment of severe aortic regurgitation: The J-Valve transfemoral system. EuroIntervention, 2019, 14(15): e1553-e1555.
30.	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.
31.	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.
32.	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.
33.	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.

1. Supino PG, Borer JS, Preibisz J, et al. The epidemiology of valvular heart disease: A growing public health problem. Heart Fail Clin, 2006, 2(4): 379-393.
2. Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol, 2010, 55(25): 2789-2800.
3. Goldbarg SH, Halperin JL. Aortic regurgitation: Disease progression and management. Nat Clin Pract Cardiovasc Med, 2008, 5(5): 269-279.
4. Flint N, Wunderlich NC, Shmueli H, et al. Aortic regurgitation. Curr Cardiol Rep, 2019, 21(7): 65.
5. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e72-e227.
6. 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.
7. Tarantini G, Fabris T. Pure aortic valve regurgitation: SAVR is the gold standard, but TAVR is another gun. Catheter Cardiovasc Interv, 2020, 95(4): 817-818.
8. Chandola R, Cusimano R, Osten M, et al. Postcardiac transplant transcatheter core valve implantation for aortic insufficiency secondary to Impella device placement. Ann Thorac Surg, 2012, 93(6): e155-e157.
9. Ducrocq G, Himbert D, Hvass U, et al. Compassionate aortic valve implantation for severe aortic regurgitation. J Thorac Cardiovasc Surg, 2010, 140(4): 930-932.
10. Dumonteil N, Marcheix B, Lairez O, et al. Transcatheter aortic valve implantation for severe, non-calcified aortic regurgitation and narrow aortic root: Description from a case report of a new approach to potentially avoid coronary artery obstruction. Catheter Cardiovasc Interv, 2013, 82(2): E124-E127.
11. 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.
12. Markham R, Ghodsian M, Sharma R. TAVR in patients with pure aortic regurgitation: Ready to use? Curr Cardiol Rep, 2020, 22(9): 98.
13. Rotman OM, Bianchi M, Ghosh RP, et al. Principles of TAVR valve design, modelling, and testing. Expert Rev Med Devices, 2018, 15(11): 771-791.
14. Tzamtzis S, Viquerat J, Yap J, et al. Numerical analysis of the radial force produced by the Medtronic-CoreValve and Edwards-SAPIEN after transcatheter aortic valve implantation (TAVI). Med Eng Phys, 2013, 35(1): 125-130.
15. Möllmann H, Hengstenberg C, Hilker M, et al. Real-world experience using the ACURATE neo prosthesis: 30-day outcomes of 1, 000 patients enrolled in the SAVI TF registry. EuroIntervention, 2018, 13(15): e1764-e1770.
16. Reardon MJ, Feldman TE, Meduri CU, et al. Two-year outcomes after transcatheter aortic valve replacement with mechanical vs. self-expanding valves: The REPRISE Ⅲ randomized clinical trial. JAMA Cardiol, 2019, 4(3): 223-229.
17. Seiffert M, Diemert P, Koschyk D, et al. Transapical implantation of a second-generation transcatheter heart valve in patients with noncalcified aortic regurgitation. JACC Cardiovasc Interv, 2013, 6(6): 590-597.
18. Wei L, Liu H, Zhu L, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-Valve and early outcome. JACC Cardiovasc Interv, 2015, 8(14): 1831-1841.
19. Sündermann SH, Grünenfelder J, Corti R, et al. Feasibility of the Engager™ aortic transcatheter valve system using a flexible over-the-wire design. Eur J Cardiothorac Surg, 2012, 42(4): e48-e52.
20. Wernly B, Eder S, Navarese EP, et al. Transcatheter aortic valve replacement for pure aortic valve regurgitation: "on-label" versus "off-label" use of TAVR devices. Clin Res Cardiol, 2019, 108(8): 921-930.
21. Stachon P, Kaier K, Heidt T, et al. Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008-2015. Catheter Cardiovasc Interv, 2020, 95(4): 810-816.
22. Arora S, Lahewala S, Zuzek Z, et al. Transcatheter aortic valve replacement in aortic regurgitation: The U. S. experience. Catheter Cardiovasc Interv, 2021, 98(1): E153-E162.
23. 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.
24. Pellikka PA, Dangas G. TAVR for severe aortic regurgitation: Advancing the frontier. J Am Coll Cardiol, 2017, 70(22): 2764-2765.
25. 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.
26. Gafoor S, Sharma R. TAVR for pure native aortic regurgitation and failing regurgitant surgical bioprostheses: Alternative indication or alternative fact? JACC Cardiovasc Interv, 2017, 10(10): 1057-1059.
27. 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.
28. Liu L, Zhang J, Peng Y, et al. Learning curve for transcatheter aortic valve replacement for native aortic regurgitation: Safety and technical performance study. Clin Cardiol, 2020, 43(5): 475-482.
29. Hensey M, Murdoch DJ, Sathananthan J, et al. First-in-human experience of a new-generation transfemoral transcatheter aortic valve for the treatment of severe aortic regurgitation: The J-Valve transfemoral system. EuroIntervention, 2019, 14(15): e1553-e1555.
30. 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.
31. 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.
32. 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.
33. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Advances in transcatheter aortic valve replacement for pure aortic regurgitation

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