Aims: We sought to evaluate the outcome of transcatheter aortic valve replacement (TAVR) with the CoreValve Revalving System (CRS-TAVR) in inoperable patients presenting with severe aortic regurgitation (AR), compared to in patients treated for severe native aortic stenosis (AS).
Methods and results: From October 2008 to January 2013, 1,557 consecutive patients undergoing CRS-TAVR, of whom 26 (1.6-) presented with AR, were prospectively followed. Compared with patients with AS, patients with AR were significantly younger (mean age 73±10 vs. 82±6, p=0.02), more frequently in NYHA Class III/IV (95- vs. 73-, p=0.01) and had a higher incidence of severe pulmonary hypertension (sPAP >60 mmHg, 31- vs. 10-, p=0.007). Log EuroSCORE and STS score were similar. VARC-2-defined device success was lower in the AR group (79- vs. 96-, p=0.006). At one month, patients treated for AR had a higher overall mortality (23- vs. 5.9-; OR 4.22 [3.03-8.28], p<0.001) and cardiac mortality (15.3- vs. 4-, OR 4.01 [2.40-7.66], p<0.001). Results were consistent at 12 months: overall mortality (31- vs. 19-, HR 2.1 [1.5-4.41], p<0.001) and cardiac mortality (19.2- vs. 6-, HR 3.1 [2.09-8.22], p<0.001).
Conclusions: CRS-TAVR for AR is associated with a significantly higher mortality compared to CRS-TAVR for AS. Considering the ominous prognosis of these patients when treated medically, TAVR may be a reasonable choice in selected patients. In this regard, conventional risk scores have an inadequate predictive value.
- Aortic regurgitation
- Transcatheter aortic valve replacement
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine