Outcomes of transcatheter aortic valve implantation for native aortic valve regurgitation

• Published in: EuroIntervention Vol. 20; no. 17; pp. e1076 - e1085
• Main Authors: Le Ruz, Robin, Leroux, Lionel, Lhermusier, Thibault, Cuisset, Thomas, Van Belle, Eric, Dibie, Alain, Palermo, Vincenzo, Champagnac, Didier, Obadia, Jean-François, Teiger, Emmanuel, Ohlman, Patrick, Tchétché, Didier, Le Breton, Hervé, Saint-Etienne, Christophe, Piriou, Pierre-Guillaume, Plessis, Julien, Beurtheret, Sylvain, Du Chayla, Florence, Leclère, Manon, Lefèvre, Thierry, Collet, Jean-Philippe, Eltchaninoff, Hélène, Gilard, Martine, Iung, Bernard, Manigold, Thibaut, Letocart, Vincent, Of Stop-As And France-Tavi Investigators, On Behalf
• Format: Journal Article
• Language: English
• Published: France EuroPCR 02.09.2024
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Insufficiency - surgery; Bioengineering; Female; France; Heart Valve Prosthesis; Humans; Life Sciences; Male; Registries; Risk Factors; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - methods; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; France
• ISSN: 1774-024X; 1969-6213
• DOI: 10.4244/EIJ-D-24-00339

Large datasets of transcatheter aortic valve implantation (TAVI) for pure aortic valve regurgitation (PAVR) are scarce. We aimed to report procedural safety and long-term clinical events (CE) in a contemporary cohort of PAVR patients treated with new-generation devices (NGD). Patients with grade III/IV PAVR enrolled in the FRANCE-TAVI Registry were selected. The primary safety endpoint was technical success (TS) according to Valve Academic Research Consortium 3 criteria. The co-primary endpoint was defined as a composite of mortality, heart failure hospitalisation and valve reintervention at last follow-up. From 2015 to 2021, 227 individuals (64.3% males, median age 81.0 [interquartile range {IQR} 73.5-85.0] years, with EuroSCORE II 6.0% [IQR 4.0-10.9]) from 41 centres underwent TAVI with NGD, using either self-expanding (55.1%) or balloon-expandable valves (44.9%; p=0.50). TS was 85.5%, with a non-significant trend towards increased TS in high-volume activity centres. A second valve implantation (SVI) was needed in 8.8% of patients, independent of valve type (p=0.82). Device size was ≥29 mm in 73.0% of patients, post-procedure grade ≥III residual aortic regurgitation was rare (1.2%), and the permanent pacemaker implantation (PPI) rate was 36.0%. At 30 days, the incidences of mortality and reintervention were 8.4% and 3.5%, respectively. The co-primary endpoint reached 41.6% (IQR 34.4-49.6) at 1 year, increased up to 61.8% (IQR 52.4-71.2) at 4 years, and was independently predicted by TS, with a hazard ratio of 0.45 (95% confidence interval: 0.27-0.76); p=0.003. TAVI with NGD in PAVR patients is efficient and reasonably safe. Preventing the need for an SVI embodies the major technical challenge. Larger implanted valves may have limited this complication, outweighing the increased risk of PPI. Despite successful TAVI, PAVR patients experience frequent CE at long-term follow-up.