Original title: Transcatheter Aortic Valve Implantation for Pure Severe Native Aortic Valve Regurgitation. Reference: David A. Roy et al. J Am Coll Cardiol 2013. Article in press.

Percutaneous aortic valve replacement (TAVI) has become a standard treatment for patients with severe aortic stenosis and a high surgical risk.

However for those patients who have pure aortic insufficiency, (failure without associated stenosis), nothing has yet been published. This is a world record that included 43 volunteer patients with pure aortic insufficiency treated with TAVI using Valve Core valve, (Medtronic, Minneapolis, Minnesota). All patients were rejected for surgery with a mean logistic EuroSCORE of 26.9 ± 17.9%. 

The average measurement of the aortic ring was 24 ± 2.3 mm and the most commonly used valve was n° 29. In 42 of the 43 patients (97.7%) it was possible to implant the valve, with 8 patients (18.6%) requiring a second valve for residual aortic insufficiency. 

All patients requiring a second valve had an absence of calcium in the ring, (p = 0.014). Post implant they showed aortic insufficiency of grade I or less 34 patients, (79.1%). Death from any cause whatsoever at one year was 21.4%.

Conclusion:

This study demonstrates the feasibility and potential difficulties of treating patients with pure aortic surgery by percutaneous aortic valve implantation with Core Valve prosthesis. The chances of significant aortic insufficiency, despite the implant, persists or that more than one valve will be needed should be considered before making the decision.

Editorial comment: 

The frequent absence of calcium that serves as a guide becomes more challenging for the implant in these patients compared to those with stenosis and is usually a harmful ring calcification. In case the significant aortic insufficiency remains after the release, it is unlikely, (in the absence of calcium), that the post dilatation improves the situation which leaves no choice but the implantation of a second valve. The worst prognosis was for patients with aortic regurgitation and aneurysmal dilatation of the ascending aorta, (3 out of 4 died within 6 months). This suggests (despite the small number of patients) that TAVI does not alter the course of the disease when the failure is associated with root dilatation.

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