TAVR as a Viable Option for Patients with Pure Native Aortic Regurgitation

Abstract Surgical aortic valve replacement (SAVR) is now considered the gold standard in the management of aortic regurgitation (AR). However, transcatheter aortic valve replacement (TAVR) is increasingly being used for the therapy of high-risk patients. The latest Chinese expert consensus states that TAVR can be used as one of the strategies for the treatment of pure AR, and no longer exists as an off-label option, providing a new way of thinking about the treatment of pure AR patients. We comprehensively searched PUBMED, EMBASE, OVID, Web of Science, and Cochrane Library from the construction of the database to March 28, 2024, to obtain eligible clinical trial data for analysis. The study protocol was registered in PROSPERO (CRD42024529532). A total of 21 studies (5,978 patients) were included in the analysis. Device success rates ranged from 74 to 100%. Among these, 23 patients (0.35%) required implantation of a second valve. Thirty-five patients (0.59%) underwent intraoperative conversion to SAVR. The primary outcome—all-cause mortality within 30 days—was observed in 272 patients (4.6%). Secondary outcomes are summarized as follows: 120 patients (2.01%) experienced myocardial infarction within 30 days, and 110 patients (1.84%) experienced cerebrovascular events; major bleeding occurred in 384 patients (6.42%), while major vascular complications were lowest at 51 cases (0.85%). Four hundred two patients (6.72%) required permanent pacemaker implantation, and 266 patients (4.45%) experienced acute kidney injury. The incidence of moderate or severe postoperative AR was 61 cases (1.02%). AR could be an indication for transfemoral TAVR, which would benefit patients.