Key result
Transfemoral TAVR guided by a novel anatomic classification achieved a 100% procedural success rate and 93.8% device success rate in patients with severe native aortic regurgitation.
Why the study?
The success of TAVR in native AR is limited by the absence of calcified anchoring structures, prompting evaluation of a novel aortic root imaging classification.
Does a novel MDCT-based anatomic classification and dual-anchoring strategy improve procedural success and safety of transfemoral TAVR in patients with severe native aortic regurgitation?
Cohort (n=81)
Yes
Does a novel MDCT-based anatomic classification and dual-anchoring strategy improve procedural success and safety of transfemoral TAVR in patients with severe native aortic regurgitation?
A novel MDCT-based anatomic classification can identify suitable candidates for TAVR in pure native aortic regurgitation, achieving high procedural success and short-term safety.
Answers are grounded in this paper and cite their sources.
Offers a potential option for high-risk native AR patients; leaves open need for randomized validation of the classification.
BACKGROUND: The success of transcatheter aortic valve replacement (TAVR) in native aortic regurgitation (AR) is limited by the absence of calcified anchoring structures. We sought to evaluate transfemoral TAVR in patients with native AR using a novel aortic root imaging classification. METHODS: From March to November 2021, 81 patients with severe AR were prospectively enrolled in 2 cardiac centers in China. All were evaluated using multidetector computed tomography (MDCT) and classified into 4 anatomic types in reference to transcatheter heart valve (THV) anchoring: Type 1: anchoring at the left ventricular outflow tract (LVOT), annulus, and ascending aorta (AA); Type 2: anchoring at the annulus and AA; Type 3: anchoring at the annulus and LVOT; and Type 4: anchoring at only 1 level or none at all. Based on the dual-anchoring strategy, patients with Types 1-3 were considered TAVR candidates. Procedural and 30-day outcomes were assessed according to Valve Academic Research Consortium-3 definitions. RESULTS: TAVR was performed in 32 (39.5%) patients (71.9 ± 8.0 years of age, 71.9% were male) using 2 self-expanding THVs. Types 1, 2, and 3 comprised 13 (40.6%), 11 (34.4%), and 8 (25.0%) cases, respectively. The procedural and device success rates were 100% and 93.8%, respectively, with 2 THV migration. Eight patients (25.0%) required a permanent pacemaker, and 2 (6.3%) developed moderate paravalvular leaks. No deaths or other major complications occurred during the study. CONCLUSIONS: The novel anatomic classification and dual-anchoring strategy were associated with a high procedural success rate with favorable short-term safety and clinical outcomes.
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Chen et al. (2022) conducted a cohort in Severe native aortic regurgitation (n=81). Transfemoral TAVR guided by a novel anatomic classification was evaluated on Procedural success. Transfemoral TAVR guided by a novel anatomic classification achieved a 100% procedural success rate and 93.8% device success rate in patients with severe native aortic regurgitation.
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