Clinical efficacy and safety of transcatheter aortic valve replacement for patients with severe pure native aortic regurgitation.
10.3724/zdxbyxb-2024-0515
- Author:
Jiantao CHEN
;
Yi ZHANG
;
Kangni FENG
;
Suiqing HUANG
;
Hanri XIAO
;
Mengya LIANG
;
Zhongkai WU
- Publication Type:Journal Article
- Keywords:
Efficacy;
Native aortic regurgitation;
Retrospective study;
Safety;
Transapical;
Transcatheter aortic valve replacement;
Transfemoral
- MeSH:
Humans;
Transcatheter Aortic Valve Replacement/adverse effects*;
Aortic Valve Insufficiency/surgery*;
Retrospective Studies;
Male;
Female;
Aged;
Treatment Outcome;
Aortic Valve/surgery*;
Aged, 80 and over;
Heart Valve Prosthesis
- From:
Journal of Zhejiang University. Medical sciences
2025;54(4):529-540
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVES:To evaluate the early clinical efficacy and safety of trans-catheter aortic valve replacement (TAVR) for patients with severe pure native aortic regurgitation (PNAR) who are not suitable for conventional surgical aortic valve replace-ment.
METHODS:A retrospective analysis was conducted on 48 patients with PNAR who underwent TAVR at the Department of Cardiac Surgery, the First Affiliated Hospital of Sun Yat-sen University between March 2019 and February 2025. These included 25 cases with transfemoral approach (TF-TAVR group) and 23 cases with transapical approach (TA-TAVR group). Efficacy and safety were assessed by analyzing baseline characteristics, all-cause mortality, and procedure-related complications.
RESULTS:Compared with the TA-TAVR group, the TF-TAVR group exhibited significantly smaller aortic annulus circumference and diameter, left ventricular outflow tract circumference and diameter, diameters of the left, right, and non-coronary sinuses, and sinotubular junction (STJ) diameter, along with a shorter distance from the STJ to the aortic annular plane ring plane, a smaller annulus angle (all P<0.05). Additionally, the TF-TAVR group showed a deeper prosthesis implantation depth relative to the aortic annular plane (P<0.01). The overall technical success rate was 91.67%, and the device success rate was 83.33%. Post-TAVR, both groups demonstrated significant improvement in left ventricular end-diastolic diameter (both P<0.05), while only the TA-TAVR group showed significant reduction in left ventricular end-systolic diameter (P<0.05). For primary outcomes, in-hospital mortality occurred in 2 patients (4.17%). No additional deaths were reported at 60 or 90 d after surgery. During 90-180 d after surgery, one patient in the TF-TAVR group died of sudden cardiac death, and one in the TA-TAVR group died of gastroin-testinal bleeding. During 180 d-1 year after surgery, one patient in the TF-TAVR group died of low cardiac output syndrome. No statistically significant differences were observed in 1-year Kaplan-Meier survival curves between the two groups (P>0.05). No conduction block events occurred in TA-TAVR group during hospitalization or 1-year follow-up, while high-grade atrioventricular block, left bundle branch block, permanent pacemaker implantation occurred in TF-TAVR group during hospitalization (12.00%, 4.00%, and 12.00%, respectively).
CONCLUSIONS:TAVR demonstrates high feasibility and acceptable safety for severe PNAR patients who are not suitable for conventional SAVR. Both TF-TAVR and TA-TAVR show comparable early postoperative efficacy and safety profiles.
