Transapical transcatheter aortic valve for severe aortic regurgitation: expanding the limits.

Abstract

OBJECTIVES:

This study sought to evaluate the self-expandable ACURATE TA device (Symetis SA, Ecublens, Switzerland) in a cohort of patients with pure aortic regurgitation (AR).

BACKGROUND:

Transcatheter aortic valve replacement (TAVR) has been initially considered as an alternative for high-risk patients with aortic stenosis. Although the current experience is limited, TAVR might be also an alternative to treat patients with pure, severe AR.

METHODS:

Between April 2012 and December 2013, a total of 8 high-risk patients with pure, severe AR were enrolled (grade III+). Clinical and hemodynamic data as well as data on device and procedure parameters and outcomes were collected.

RESULTS:

Patient mean was 72.5 ± 8.4 years, and 37.5% of patients were female. Logistic EuroSCORE was 34.0 ± 7.9% and the Society of Thoracic Surgeons score was 7.3 ± 3.3% on average. Two patients had undergone emergency aortic operation before due to acute type A aortic dissection, and both were treated by replacement of the ascending aorta (including root reconstruction) and the aortic arch combined with or without E-vita Open stent graft (Jotec GmbH, Hechingen, Germany) (January 2011 and March 2012), whereas the other patients experienced primary AR. All patients underwent successful transapical TAVR with the transapical ACURATE TA device (size small, n = 1, size medium, n = 3, size large, n = 4) without any intraprocedural complications according to the Valve Academic Research Consortium 2 criteria. Post-procedure AR grade I+ or lower, as revealed by transoesophageal echocardiography and angiography, was present in all 8 patients. At 30 days, the stroke incidence and all-cause mortality rate were 0%.

CONCLUSIONS:

This small single-center series demonstrates the feasibility of transapical TAVR with the self-expandable ACURATE TA device in high-risk patients with severe AR.

• Authors: Daniel Wendt, Philipp Kahlert, Susanne Pasa, Karim El-Chilali, Fadi Al-Rashid, Konstantinos Tsagakis, Daniel Sebastian Dohle, Raimund Erbel, Heinz Jakob, Matthias Thielmann
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 7 Issue 10 Pg. 1159-67 (Oct 2014) ISSN: 1876-7605 [Electronic] United States
• PMID: 25129668 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (diagnostic imaging, physiopathology)
• Aortic Valve Insufficiency (diagnosis, physiopathology, therapy)
• Cardiac Catheterization (adverse effects, instrumentation, methods)
• Coronary Angiography
• Echocardiography, Doppler, Color
• Echocardiography, Transesophageal
• Feasibility Studies
• Female
• Germany
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (adverse effects, instrumentation, methods)
• Hemodynamics
• Humans
• Male
• Middle Aged
• Prosthesis Design
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Time Factors
• Treatment Outcome