Original title: Initial German Experience With Tranapical Implantation of a Second-Generation Trascatheter heart Valve for the Treatment of Aortic Regurgitation. Reference: Moritz Seiffert, et al. JACC Cardiovasc Interv. 2014 Oct;7(10):1168-74.
There is a group of patients with severe aortic regurgitation and they are not candidates for surgery; percutaneous implant is an option, but until now, there is little information.This study included 31 patients with severe aortic regurgitation surgery discarded for high surgical risk who received the JenaValve implant via transapical.The mean age was 74 years and the majority (28/31) were in functional class III or IV. Pathophysiology of aortic regurgitation was degenerative in 15 patients, annular dilation in six, post endocarditis in four, rheumatic in in one, post radiation inone and unknown cause in four.The aortic valve was implanted successfully in 30 patients with no significant residual aortic insufficiency observedor the need for surgical conversion.
Four procedures were combined including two MitraClip, one closing of prior mechanical mitral valve periprosthetic leakage and one left ventricular assist device implant.At 30 days, three patients died of noncardiac causes and one for cardiac cause one; no infarcts or strokes were observed. Three patients had important complications related to access.At follow-up at 6 months 2 deaths for non-cardiac cause and two re-interventions were observed (one valve replacement and one surgery for endocarditis). No patient had moderate or severe aortic regurgitation; improvement of functional class remained at 30 days.
Conclusion
Aortic regurgitation remains a challenge for TAVI. This multicenter study with JenaValveshows that it is a reasonable option in this patient group. However, significant non-cardiac cause mortality in this high-risk group emphasizes the need for careful patient selection.
Editorial comment
Endovascular treatment for severe aortic insufficiency in high-risk patients generates a new challenge. The anatomy is different; the lack of calcification favors the valve “anchoring” absence, in addition to embolization, residual aortic regurgitation, leaks and aortic or valvular damage.This short-term analysis shows that it is feasible and safe, but deep monitoring and valves development of this disease are needed.
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation
Buenos Aires-Argentina
Carlos Fava
