Transfemoral Transcatheter Aortic Valve Replacement for Pure Native Aortic Regurgitation: One-Year Outcomes of a Single-center study

doi:10.21203/rs.3.rs-2815531/v1

Download PDF

Research Article

Transfemoral Transcatheter Aortic Valve Replacement for Pure Native Aortic Regurgitation: One-Year Outcomes of a Single-center study

https://doi.org/10.21203/rs.3.rs-2815531/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 29 Jun, 2023

Read the published version in BMC Cardiovascular Disorders →

You are reading this latest preprint version

Background

Evidence about safety and efficacy of transcatheter aortic valve replacement (TAVR) with the Venus A-Valve system (Venus Medtech, Hangzhou, China) remains limited for patients with pure native aortic regurgitation (PNAR).

Objectives

The single-center study sought to report the one-year clinical outcomes of the Venus A-Valve in the treatment of PNAR.

Methods

This study was a retrospective analysis of prospectively collected data. Data was from all consecutive patients who had PNAR and underwent TAVR with the Venus A-Valve at three Chinese centers from June 2019 and July 2022. Procedural and clinical outcomes up to one year were analyzed using Valve Academic Research Consortium-2 criteria.

Results

A total of 45 consecutive patients with PNAR underwent transfemoral TAVR with the Venus A-Valve across three participating centers between June 2019 and July 2022. The Mean age was 73.5 ± 5.5 years and 26.7% were female. All the TAVR procedures were performed via transfemoral access without cardiopulmonary bypass. Implantations were successful in 44 cases (97.8%). Only one patient was converted to surgical aortic valve replacement. No patient died intraoperatively. No second valve was implanted. In-hospital mortality rate was 2.3%. The one-year all-cause mortality rate was 4.7% without cardiovascular related death. No patient had moderate or severe paravalvular leakage during follow-up. At one year, the mean pressure gradient was 8.8 ± 0.9 mmHg, and left ventricular ejection fraction increased to 61.5 ± 3.6%.

Conclusions

This single-center study demonstrated the safety and efficacy of transfemoral TAVR with the Venus A-Valve in the treatment of patients with PNAR.

Transcatheter aortic valve replacement (TAVR)

pure native aortic regurgitation (PNAR)

Venus A-Valve

clinical outcomes

Aortic regurgitation (AR) affects about 13% of patients suffering from native valvular heart diseases [1]. Pure native aortic regurgitation (PNAR) is usually characterized by leaflet degeneration, aortic root dilatation with aortic annulus enlargement, or both [2]. Related symptoms tend to appear later in the disease courses, when left ventricular (LV) dilatation and systolic dysfunction is already settled, both being risk factors of a dismal prognosis [3]. Intervention is indicated in the case of significant PNAR accompanied by symptoms, resting left ventricular ejection fraction (LVEF) ≤ 50%, or left ventricular end systolic dimension (LVESD) > 50 mm [4]. It is well known that surgical aortic valve replacement (SAVR) remains the standard treatment for patients with PNAR. However, some patients have high surgical risks and postoperative mortality, resulting in many patients losing the chances of surgery. When left untreated, these patients face an annual mortality risk of 20% [5].

Transcatheter aortic valve replacement (TAVR) has been proved to be an effective treatment of aortic valve diseases in patients considered at high risk of mortality or morbidity with SAVR [6]. However, for PNAR, TAVR is considered “off-label” for almost all transcatheter valves [7]. This is because the mainstream TAVR aortic valves were originally designed for aortic stenosis relying on oversizing and radial forces of the prosthesis to anchor to the calcific aortic valve. The presence of large annular anatomy and the absence of valvular calcification have made the transcatheter treatment of PNAR challenging, mainly due to the risk of inadequate anchoring, prosthesis dislodgment, and residual paravalvular leak (PVL) after implantation [8]. With technological development of transcatheter valves, the new-generation valves with the external sealing cuff and unique anchoring mechanisms could potentially overcome the technical challenges in treating PNAR [9]. In the latest updated American College of Cardiology/American Heart Association guideline, it is stated that TAVR may be considered in experienced centers for selected patients with PNAR who are ineligible for SAVR [10].

The Venus A-Valve system (Venus Medtech, Hangzhou, China) is made of a self-expanding nitinol frame and tri-leaflet bovine pericardial valve [11]. Several studies indicated that this valve is feasible for the treatment of PNAR, but the experience was still limited [12]. We now report the one-year outcomes of the single-center study with transfemoral implantation of the Venus A-Valve in patients with PNAR.

Study design

The study was a retrospective analysis of prospectively collected data. Data was from all consecutive patients who had PNAR and underwent TAVR with the Venus A-Valve at our center from June 2019 and July 2022.

Every patient experienced clinical examination, laboratory test, transthoracic echocardiography and contrast-enhanced multidetector computed tomography (MDCT) at admission. The degree of AR is graded by measurement of the narrowest width of the proximal regurgitant jet (vena contracta) by Colour Doppler [13]. A jet width < 0.3 cm indicates mild AR, while a width > 0.6 cm indicates severe AR.

All patients were evaluated by our heart team before operation and considered to be at prohibitive or high risk for SAVR. The inclusion criteria were: (1) age ≥ 60 with New York Heart Association (NYHA) functional class II-IV, (2) symptomatic PNAR with resting LVEF ≤ 50% or LVESD > 50 mm, (3) logistic EuroScore ＞ 20%. The exclusion criteria were: (1) patients with failed bioprosthetic surgical heart valves, (2) dimension of aortic root ＞ 50 mm, (3) diameter of aortic annulus ＞ 29 mm or ＜18 mm, (4) aortic stenosis with peak aortic valve pressure gradient ＞ 20 mmHg or peak aortic velocity > 2.5 m/s, (5) serious comorbidities such as acute aortic dissection, severe coagulation disorder, and multiple organ failure.

Comprehensive clinical and echocardiographic assessments were scheduled before discharge and at 30 days, 6 months, and one year after the procedure. Clinical follow-up was performed by direct or telephone interview according to each center^’s practice. Data on baseline characteristics, operative details, postoperative outcomes, and follow-up information were collected prospectively and entered electronically in a dedicated Microsoft Access database.

TAVR procedures

Pre-procedure aorta-iliac-femoral computed tomography was performed to evaluate the size of vessel caliber and feasibility of transfemoral approach. MDCT was used to assess the morphology of the aortic valve and root (Figure 1). The dimension of aortic annulus (AA), left ventricular outflow tract (LVOT), sinotubular junction (STJ), and aortic root were measured, as well as the distance between the ostia of coronary arteries and the annulus.

All TAVR procedures were conducted using standard techniques, and the Venus A-Valve were implanted. Briefly, the procedure was performed under general anesthesia and transesophageal echocardiogram guidance. Two pigtail catheters were positioned in the aortic sinus as an annulus landmark (Figure 2A). The Venus A-Valve was carefully advanced until the annulus, highly positioned (Figure 2B), and slowly deployed under rapid ventricular pacing (180-220 beats/min) (Figure 2C, D). After final deployment, rapid ventricular pacing was kept at 120-140 beats/min until delivery system removal, to assure a stable final position (Figure 2E). Prosthetic valve position and hemodynamics were assessed instantly after implantation by both angiography and transesophageal echocardiography.

Study endpoints

Procedural and clinical outcomes up to one year were analyzed using Valve Academic Research Consortium-2 criteria [14]. The primary endpoint was the implantation success, defined as: proper position and function of the prosthesis (peak aortic valve pressure gradient < 20 mm Hg, peak aortic velocity < 3 m/s, and absence of moderate or severe AR). Secondary endpoints were all-cause and cardiovascular mortality. Other endpoints included procedure- and valve-related complications, and echocardiographic assessment of the valve and cardiac function.

Statistical analysis

Continuous variables are shown as mean ± standard deviation, and categorical variables are presented as raw counts and percentages. Between-group differences were analyzed using paired t test. All analyses were conducted using SPSS version 20.0 (IBM, Armonk, New York, USA). P values < 0.05 were considered statistically significant.

Baseline characteristics

A total of 45 consecutive patients with PNAR underwent transfemoral TAVR with the Venus A-Valve across three participating centers between June 2019 and July 2022. The mean age was 73.5 ± 5.5 years and 26.7% were female. One patient had congenital bicuspid aortic valve, while the others had tricuspid aortic valves. The mean risk score according to the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 28.5 ± 7.5%, and 95.6% of the patients were in NYHA functional class ≥ III. The detailed description of patient characteristics was listed in Table 1.

Table 1

Baseline Characteristics
Characteristic	Value
Age (years)	73.5 ± 5.5
Female	12 (26.7)
Body mass index (kg/m²)	22.5 ± 3.5
Hypertension	22 (48.9)
Diabetes mellitus	12 (26.7)
Chronic pulmonary disease	19 (42.2)
Chronic renal dysfunction	10 (22.2)
Peripheral vascular disease	5 (11.1)
Prior cerebrovascular accident	8 (17.8)
Anemia	9 (20.0)
Atrial fibrillation	4 (8.9)
Coronary artery disease	7 (15.6)
Prior myocardial infarction	0
Prior PCI	5 (11.1)
Prior CABG	0
Prior mitral valve surgery	2 (4.4)
Prior permanent pacemaker implantation	2 (4.4)
Etiology
Degenerative	18 (40.0)
Rheumatic	26 (57.8)
Bicuspid aortic valve	1 (2.2)
Aortic regurgitation
≤ Moderate	0
Moderate to Severe	10 (22.2)
Severe	35 (77.8)
Mitral regurgitation ≥ moderate	16 (35.6)
Pulmonary hypertension	11 (24.4)
Logistic EuroSCORE, %	28.5 ± 7.3
NYHA functional class
I	0
II	2 (4.4)
III	14 (31.1)
IV	29 (64.4)
Values are expressed as mean ± standard deviation or number (%). NYHA = New York Heart Association; EuroSCORE = European System for Cardiac Operative Risk Evaluation; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft surgery.

Procedural details and in-hospital outcomes

All the TAVR procedures were performed via transfemoral access without cardiopulmonary bypass. The procedure was successful in 97.8% (44/45). One patient was converted to SAVR because of valve embolism into aortic arch, and recovered well after the aortic valve and hemi-arch replacement. In our study, the 24-mm, 27-mm, and 30-mm valve was implanted in 3 patients (6.8%), 23 patients (52.2%), and 18 patients (40.9%), respectively. The average procedural time were 71.1 ± 16.6 min. No patient died intraoperatively. One patient with a bicuspid aortic valve had moderate PVL, and died of low cardiac output syndrome after refusing further treatment on postoperative day 5. The other patients developed PVL no more than mild degree. Additionally, no balloon post-dilation was performed in any patient. No coronary obstruction, prosthesis malposition, annular rupture or new cerebrovascular accident occurred. No second valve or new permanent pacemaker was implanted. Two patients needed blood transfusion due to preprocedural anemia. According to the Acute Kidney Injury (AKI) Network classification [15], five patients with prior chronic renal dysfunction developed stage 1 AKI, while the renal function gradually recovered before discharge. In-hospital mortality rate was 2.3%. The mean duration of intensive care unit (ICU) stay and postoperative hospital stay was 2.5 ± 0.5 and 4.0 ± 1.5 days, respectively. Procedural details and in-hospital outcomes were listed in Table 2.

Table 2

Procedural Details and In-Hospital Outcomes
Parameter	Value
Aortic annulus diameter	n = 45
MDCT perimeter-derived, mm	26.3 ± 2.5
MDCT area-derived, mm	26.0 ± 2.4
STJ diameter, mm	38.2 ± 5.5
LCA ostium height, mm	13.5 ± 3.3
RCA ostium height, mm	15.2 ± 5.3
Ascending aortic diameter, mm	42.5 ± 5.9
Aortic root diameter, mm	39.8 ± 5.5
Successful implantation	44 (97.8)
Conversion to SAVR	1 (2.2)
THV size	n = 44
24 mm	3 (6.8)
27 mm	23 (52.2)
30 mm	18 (40.9)
Procedure time, min	71.1 ± 16.6
Contrast agent, mL	85.5 ± 22.5
Balloon post-dilation	0
Combined PCI	0
Coronary obstruction	0
Prosthesis malposition	0
Annulus rupture	0
New cerebrovascular events	0
Second valve implantation	0
New permanent pacemaker implantation	0
Transfusion	2 (4.7)
Acute kidney injury	0
Stage 1	5 (11.6)
Stage 2 or 3	0
Central aortic prosthetic regurgitation	n = 44
None or trace	43 (100)
≥ Mild	0
Procedure-related death	0
In-hospital mortality	1 (2.3)
ICU stay, days	2.5 ± 0.5
Post operation In-hospital stay, days	4.0 ± 1.5
Values are expressed as mean ± standard deviation or number (%). MDCT, multidetector computed tomography; STJ, sinotubular junction; LCA, left coronary artery; RCA, right coronary artery; SAVR, surgical aortic valve replacement; THV, transcatheter heart valve; PCI = Conversion to conventional surgery aortic valve replacement; ICU = intensive care unit.

One-year outcomes

All patients were followed up postoperatively up to one year. No patient was missing. The one-year all-cause mortality rate was 4.7% without cardiovascular related death. One patient died of severe acute pancreatitis 9 months after discharge, and the other patient died of a car accident 11 months after discharge. All of the remaining 41 patients fortunately survived. Only one patient was in NYHA functional class III, who developed a third-degree atrioventricular block 10 months after discharge and received permanent pacemaker implantation. No patient experienced new myocardial infarction, new cerebrovascular accident, valve thrombosis, or valve-related reintervention. Detailed outcomes at one-year follow-up were listed in Table 3.

Table 3

One-Year Clinical Outcomes
Parameter	Value
All-cause mortality	2 (4.7)
Cardiovascular mortality	0
NYHA functional class	n = 41
I or II	40 (97.6)
III	1 (2.4)
IV	0
New permanent pacemaker implantation	1 (2.4)
New Myocardial infarction	0
New cerebrovascular accident	0
Valve thrombosis	0
Valve-related reintervention	0
Central aortic prosthetic regurgitation	n = 41
None or trace	41 (100)
≥ Mild	0
Mitral regurgitation ≥ moderate	3 (7.3)
Values are expressed as mean ± standard deviation or number (%). NYHA = New York Heart Association.

Echocardiography assessments

The degree of AR at baseline and the PVL during follow-up were listed in Fig. 3. No patient had moderate or severe PVL at one month, six months and twelve months. The mean pressure gradient was 8.1 ± 1.2 mmHg at one month, 8.8 ± 0.9 mmHg at one year (Fig. 4). The aortic valve peak velocity remained stable at one month, six months and twelve months. The LVEF significantly increased from 41.5 ± 4.6% at baseline to 61.5 ± 3.6% at one year (Fig. 5). Additionally, significant decreases were observed in LVEDD (from 62.1 ± 4.9 mm at baseline to 46.0 ± 3.6 mm at one year) and LVESD (from 51.2 ± 4.8 mm at baseline to 36.9 ± 3.7 mm at one year).

This single-center study confirmed the feasibility of transfemoral TAVR with the Venus A-Valve in patients with PNAR. The procedure was successful in 97.8%. No patient died intraoperatively. No second valve was implanted in any case. Echocardiographic measurements showed adequate hemodynamic function without PVL > moderate degree, significant improvement in LVEF and decreased mean pressure gradient during one-year follow-up.

The Venus A-Valve system has some unique advantages [16–17]. First, it can be fully retrievable if there is significant residual PVL or the prosthesis position is not proper; second, it has the repositionability to fine tune the final deployment; third, it can check the stability of the prosthesis by a push-and-pull test using the positioning wires. Despite these advantages, in our early procedures, one patient was converted to SAVR due to valve embolism into the aortic arch. Of note, prosthetic valve dimension was not the only factor implied in this valve embolization event. The increased stroke volume caused by significant AR and the low implantation height due to the absence of fluoroscopic calcific landmarks may also be the important factors [18]. To prevent this complication, we updated our protocol in subsequent cases, such as a prolonged observation time without removing the wires to avoid valve inversion in case of embolization and to allow subsequent balloon recapture maneuvers. Since then, valve embolization never happened again.

The diameter of aortic annulus for sizing the prosthesis was calculated by the perimeter and area of the native aortic annulus [19]. Of note, it was necessary to have 10–20% oversizing of the native aortic annulus to minimize the risk of insufficient prosthesis anchoring and PVL [20]. Oversizing beyond 20% was not recommended due to the risk of annular rupture and conduction system abnormality [21]. Published data suggested that PNAR relied on AA, LVOT, STJ, and thickening leaflet to provide the anchoring force for the prosthetic valve [22]. AA and LVOT played a major anchoring role. STJ may provide an anchoring for the “crown” of the prosthetic valve and avoid it slipping down. Moreover, the thickening leaflets provides the much greater friction between the native valve and prosthetic valve frame. In our study, no patient had balloon post-dilation, prosthesis malposition, annulus rupture or second valve implantation. Only one patient (1/41, 2.4%) had new permanent pacemaker who developed a third-degree atrioventricular block 10 months after the procedure. Overall, the complications are less frequent than other studies using self-expanding valves [23–24].

A proportion of PNAR is caused by annular dilation due to aortic aneurysm, Marfan syndrome, bicuspid aortic valve, etc [25]. It is important that TAVR may be ineffective in altering the prognosis of these patients. Some studies suggested [26] that patients with ascending aorta aneurysm responded poorly to treatment of TAVR (75% of the patients died 6 months after valve implantation). It may be due to that the aortic diameter is still increasing after TAVR. Additionally, bicuspid aortic valve, especially Type-0 (2 aortic sinuses and 2 valve leaflets with no raphe), was regarded as a contradiction to TAVR because of no inadequate anchoring position [27]. In our study, one patient with bicuspid aortic valve (type 1) had moderate PVL after the treatment, as the positioning of the prosthesis was affected by the raphe of the native valve. So, careful selection and morphology assessment was needed for bicuspid aortic valve patients.

Notley, 13 of 16 patients had amelioration of concomitant mitral regurgitation from moderate or greater to mild or trace in our study. The progression of mitral regurgitation is secondary to the increase of the left ventricle-to-atrium pressure gradient and progressive left ventricle adverse remodeling which involves the mitral valve structure [28]. After TAVR implantation, two mechanisms act together contributing to the regression of mitral regurgitation [29]: (1) the reduction of left ventricle diastolic volume and the change of left ventricle geometry; and (2) the reduction of left ventricle cavity pressure leading to the reduction of the ventricle-to-atrium pressure gradient. Thereafter, left ventricle adverse remodeling is gradually reversed, including mitral valve morphology.

In our experience, several technical points should be noted. First, it is critical to determine the size of the prosthetic valve accurately before implantation. Second, high valve implantation (not lower than 4–5 mm in the left ventricular) assures a more proper valve oversizing, reducing PVL, and minimizing the risk of damaging the atrioventricular conduction system. Third, two pigtail catheters should be positioned in the aortic sinuses and transesophageal echocardiography is essential to guide the valve implantation. Moreover, rapid ventricular pacing is necessary to reduce stroke volume, stabilize the annulus, and limit prosthesis motion. Last but not least, cardiopulmonary bypass should be prepared in some special cases.

Study Limitations

This study included a relatively small number of patients. The longest follow-up period was limited to one year. Further research with a larger patient population and longer follow-up duration are scheduled.

This single-center study demonstrated the feasibility of transfemoral TAVR with the Venus A-Valve in patients with PNAR. Procedural and one-year follow-up results were promising. Continued observation is now warranted to confirm persistent valve function during long-term follow-up.

Ethical approval and consent to participate

This study was approved by the Institutional Review Board of Southwest Hospital of Third Military Medical University (Army Medical University) KY2022156 and conducted in accordance with the Declaration of Helsinki (as revised in 2013). The Institutional Review Board of Southwest Hospital of Third Military Medical University (Army Medical University) waived the need for informed consent

Consent for publication

Not applicable.

Availability of data and materials

The data that support the findings of this study are available from the corresponding authors upon reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

Not applicable.

Author contributions

JL, PH and WC were responsible for the study concept and design. HJZ, YBC, CJY, DQL, SJY, JL, PH and WC were responsible for the acquisition and analysis of data. All authors contributed to the interpretation of the data. HJZ and YBC drafted the manuscript. The corresponding author attests that all listed authors meet authorship criteria. All authors read and approved the final manuscript.

Acknowledgements

Not applicable.

Tagliari AP, Petersen SR, Keller SE. Transcatheter Aortic Valve Implantation for Pure Native Aortic Regurgitation: The Last Frontier. J Clin Med. 2022, 11(17).
El-Gamel A. Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation: Challenging Pathology Awaiting Specialized Devices. Aorta (Stamford). 2021, 9(2): 56-9.
Haddad A, Arwani R, Altayar O, Sawas T, Murad MH, de Marchena E. Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation: A systematic review and meta-analysis. Clin Cardiol. 2019, 42(1): 159-66.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JR, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017, 135(25): e1159-95.
Chen S, Zheng F, Li M, Hou S, Zhang W, Zhang L, et al. A study on correlation between preprocedural CT indexes and procedural success rate of transfemoral transcatheter aortic valve replacement with different self-expanding valves (VitaFlow or VenusA-Valve) in patients with pure native aortic regurgitation. Ann Transl Med. 2022, 10(11): 643.
Avvedimento M, Tang G. Transcatheter aortic valve replacement (TAVR): Recent updates. Prog Cardiovasc Dis. 2021, 69(4): 73-83.
Wernly B, Eder S, Navarese EP, Kretzschmar D, Franz M, Alushi B, 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): 921-30.
Jiang J, Liu X, He Y, Xu Q, Zhu Q, Jaiswal S, et al. Transcatheter Aortic Valve Replacement for Pure Native Aortic Valve Regurgitation: A Systematic Review. Cardiology. 2018, 141(3): 132-40.
Markham R, Ghodsian M, Sharma R. TAVR in Patients with Pure Aortic Regurgitation: Ready to Use? Curr Cardiol Rep. 2020, 22(9): 98.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022, 43(7): 561-632.
Liao YB, Zhao ZG, Wei X, Xu YN, Zuo ZL, Li YJ, et al. Transcatheter aortic valve implantation with the self-expandable venus A-Valve and CoreValve devices: Preliminary Experiences in China. Catheter Cardiovasc Interv. 2017, 89(S1): 528-33.
Chen S, Zheng F, Li M, Hou S, Zhang W, Zhang L, et al. A study on correlation between preprocedural CT indexes and procedural success rate of transfemoral transcatheter aortic valve replacement with different self-expanding valves (VitaFlow or VenusA-Valve) in patients with pure native aortic regurgitation. Ann Transl Med. 2022, 10(11): 643.
Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003, 16(7): 777-802.
Kappetein AP, Head SJ, Genereux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothorac Surg. 2012, 42(5): S45-S60.
Cruz DN, Bagshaw SM, Ronco C, Ricci Z. Acute kidney injury: classification and staging. Contrib Nephrol. 2010, 164(3): 24-32.
Wang R, Kawashima H, Gao C, Mou F, Li P, Zhang J, et al. Comparative Quantitative Aortographic Assessment of Regurgitation in Patients Treated with VitaFlow Transcatheter Heart Valve vs. Other Self-Expanding Systems. Front Cardiovasc Med. 2021, 8(3): 747174.
Liang Y, Wang W, Wang X, Hei F, Guan Y. A single-center analysis of outcomes, risk factors, and new valves in Asian patients treated with early transcatheter aortic valve implantation. Cardiovasc Diagn Ther. 2021, 11(4): 967-79.
Le Ruz R, Plessis J, Guimbretiere G, Roussel JC, Piriou PG, Cueff C, et al. Sapien 3 Embolization from Ventricle to Aorta in the Setting of Noncalcified Aortic Regurgitation. JACC Case Rep. 2021, 3(1): 64-8.
Orzalkiewicz M, Bruno AG, Taglieri N, Ghetti G, Marrozzini C, Galie N, et al. Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation in a Large and Noncalcified Annulus. JACC Cardiovasc Interv. 2021, 14(19): e271-e273.
Urena M, Himbert D, Ohlmann P, Capretti G, Goublaire C, Kindo M, et al. Transcatheter Aortic Valve Replacement to Treat Pure Aortic Regurgitation on Noncalcified Native Valves. J Am Coll Cardiol. 2016, 68(15): 1705-6.
Pesarini G, Lunardi M, Piccoli A, Gottin L, Prati D, Ferrero V, 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): 642-8.
Liu H, Liu S, Lu Y, Yang Y, Wang W, Zhu L, et al. Transapical transcatheter aortic valve implantation for predominant aortic regurgitation with a self-expandable valve. J Thorac Dis. 2020, 12(3): 538-49.
Liu L, Chen S, Shi J, Qin C, Guo Y. Transcatheter Aortic Valve Replacement in Aortic Regurgitation. Ann Thorac Surg. 2020, 110(6): 1959-65.
Isogai T, Saad AM, Ahuja KR, Shekhar S, Abdelfattah OM, Gad MM, et al. Short-term outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation in the United States. Catheter Cardiovasc Interv. 2021, 97(3): 477-85.
Maurer G. Aortic regurgitation. Heart. 2006, 92(7): 994-1000.
Roy DA, Schaefer U, Guetta V, Hildick-Smith D, Mollmann H, Dumonteil N, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. J Am Coll Cardiol. 2013, 61(15): 1577-84.
Yoon SH, Kim WK, Dhoble A, Milhorini PS, Babaliaros V, Jilaihawi H, et al. Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2020, 76(9): 1018-30.
Witberg G, Codner P, Landes U, Schwartzenberg S, Barbanti M, Valvo R, et al. Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality. JACC Cardiovasc Interv. 2021, 14(11): 1181-92.
Abdelghani M, Abdel-Wahab M, Hemetsberger R, Landt M, Merten C, Toelg R, et al. Fate and long-term prognostic implications of mitral regurgitation in patients undergoing transcatheter aortic valve replacement. Int J Cardiol.2019, 288: 39-43.

No competing interests reported.

Download PDF

Journal Publication

published 29 Jun, 2023

Read the published version in BMC Cardiovascular Disorders →

Editorial decision: Major revision
09 May, 2023
Reviews received at journal
01 May, 2023
Reviewers agreed at journal
24 Apr, 2023
Reviewers invited by journal
23 Apr, 2023
Editor assigned by journal
23 Apr, 2023
Editor invited by journal
22 Apr, 2023
Submission checks completed at journal
22 Apr, 2023
First submitted to journal
14 Apr, 2023

You are reading this latest preprint version

Transfemoral Transcatheter Aortic Valve Replacement for Pure Native Aortic Regurgitation: One-Year Outcomes of a Single-center study

Status:

Journal Publication

Version 1

Abstract

Figures

Introduction

Methods

Results

Baseline characteristics

Procedural details and in-hospital outcomes

One-year outcomes

Echocardiography assessments

Discussion

Study Limitations

Conclusion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1