Recommended Citation
Rayan D, Jan MF, Allaqaband S, Crouch J, Weiss E, Bajwa TK. Clinical Outcomes With Transcatheter Aortic Valve Implantation in Native and Valve-in-Valve Severe Aortic Regurgitation: Single-Center Experience. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
The off-label use of transcatheter aortic valve implantation (TAVI) for high surgical risk primary aortic regurgitation (AR) is a potential treatment option. However, limited data exists on real-world experience of TAVI to treat primary severe AR.
Purpose:
This study offers the largest single-center experience of TAVI in both native valve and valve-in-valve cases.
Methods:
Data was collected on 68 consecutive TAVIs with an indication for primary severe AR from January 1, 2012, to August 31, 2022, at our center. The principal endpoint was procedural success defined by valve placement without complications, expected post-procedural and follow-up aortic valve (AV) gradients and peak velocities, and survival at 1 and 5 years.
Results:
Median age was 80.6 (35.3% females). Fifteen cases were acute (22%) and 53 were chronic (78%) severe AR. Ten cases were index native valve replacements, and 58 were valve-in-valve. Almost all (67 of 68) had degenerative AR, except one who had infectious endocarditis. The majority were New York Health Association Class 3 or 4 (63.3%) and had an intermediate or high Society of Thoracic Surgeons risk score (59.7%). There were two periprocedural mortalities (2.9%). A Medtronic CoreValve was used in 59 cases (86.8%), and an Edwards Sapien Valve was used in eight cases (11.8%). The post-procedural mean gradient was 14 mmHg, and the post-procedure peak velocity was 2.5 m/s. Post-procedural mild or trivial residual AR was seen in 64 (95.5%) cases. Post-procedural median left ventricular end-diastolic pressure was 14 mmHg. Data on the most recent echocardiogram with a median of 411 days from procedure date showed a mean gradient of 11 mmHg and peak velocity of 2.4 m/s. One-year survival was 87.6% (76.5%, 93.6%), whereas the 5-year survival was 53.1% (32.5%, 70.0%).
Conclusions:
Treatment of severe AR with TAVI in both native and valve-in-valve is reasonable in patients with high surgical risk with a high procedural success rate in addition to excellent 1-year survival.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Clinical Outcomes With Transcatheter Aortic Valve Implantation in Native and Valve-in-Valve Severe Aortic Regurgitation: Single-Center Experience
Background/Significance:
The off-label use of transcatheter aortic valve implantation (TAVI) for high surgical risk primary aortic regurgitation (AR) is a potential treatment option. However, limited data exists on real-world experience of TAVI to treat primary severe AR.
Purpose:
This study offers the largest single-center experience of TAVI in both native valve and valve-in-valve cases.
Methods:
Data was collected on 68 consecutive TAVIs with an indication for primary severe AR from January 1, 2012, to August 31, 2022, at our center. The principal endpoint was procedural success defined by valve placement without complications, expected post-procedural and follow-up aortic valve (AV) gradients and peak velocities, and survival at 1 and 5 years.
Results:
Median age was 80.6 (35.3% females). Fifteen cases were acute (22%) and 53 were chronic (78%) severe AR. Ten cases were index native valve replacements, and 58 were valve-in-valve. Almost all (67 of 68) had degenerative AR, except one who had infectious endocarditis. The majority were New York Health Association Class 3 or 4 (63.3%) and had an intermediate or high Society of Thoracic Surgeons risk score (59.7%). There were two periprocedural mortalities (2.9%). A Medtronic CoreValve was used in 59 cases (86.8%), and an Edwards Sapien Valve was used in eight cases (11.8%). The post-procedural mean gradient was 14 mmHg, and the post-procedure peak velocity was 2.5 m/s. Post-procedural mild or trivial residual AR was seen in 64 (95.5%) cases. Post-procedural median left ventricular end-diastolic pressure was 14 mmHg. Data on the most recent echocardiogram with a median of 411 days from procedure date showed a mean gradient of 11 mmHg and peak velocity of 2.4 m/s. One-year survival was 87.6% (76.5%, 93.6%), whereas the 5-year survival was 53.1% (32.5%, 70.0%).
Conclusions:
Treatment of severe AR with TAVI in both native and valve-in-valve is reasonable in patients with high surgical risk with a high procedural success rate in addition to excellent 1-year survival.
Affiliations
Aurora St. Luke's Medical Center