Feasibility and Late Outcomes of Tavr in High–risk Patients With Pure Aortic Regurgitation

Background and Aim Transfemoral aortic valve replacement (TAVR) for pure aortic regurgitation (AR) remains under–investigated, with limited data available regarding long–term outcomes. Methods From January 2019 to June 2025, 15 patients (median age 71 years; range 47–86; 50% female) undergoing TAVR for pure AR were included in this retrospective study. All commercially available TAVR devices were considered. The primary endpoints were in–hospital and late–term mortality. Results Patients treated with TAVR for AR accounted for 1.5% of the overall TAVR volume. Contraindications to conventional surgery included advanced heart failure (33%), porcelain aorta (6%), complex redo surgeries (13%), and multiple comorbidities in the remaining patients. A balloon–expandable transcatheter heart valve (THV) was implanted in 86% of cases. The 30–day mortality rate was 6%. One patient (6%) experienced acute valve embolization requiring surgical intervention, and another required a second THV due to valve migration Postoperative pacemaker implantation in 20%. Median follow–up was 12 months (range 2–78). Three patients died during follow–up (1 cardiac cause, 1 cancer, 1 liver disease). Freedom from cardiac death at follow–up was 83% ± 11% (table 1). No cases of late THV dysfunction or redo procedures were reported (at follow–up mean transvalvular gradient 9 ± 3 mmHg; LVEF 50% ± 9%). One patient was successfully bridged to heart transplantation as intended, after three years (Figure 1). Conclusions TAVR for pure AR in selected high–risk patients demonstrated acceptable early and late mortality rates. Despite a non–negligible perioperative complication rate, THV performance at follow–up was favorable, with no cases of recurrent AR, PVL, or valve dysfunction.Figure 1