Key result
TAVR achieves 86% procedural success in rheumatic severe AS.
Why the study?
The use of transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis in rheumatic heart disease has been limited and not well characterized.
Is TAVR feasible and safe for patients with severe symptomatic aortic stenosis due to rheumatic heart disease?
Systematic Review (n=43)
Is TAVR feasible and safe for patients with severe symptomatic aortic stenosis due to rheumatic heart disease?
TAVR appears feasible for selected patients with severe rheumatic aortic stenosis, though a 14% device failure rate highlights the need for further randomized clinical trials.
TAVR may be feasible in selected rheumatic aortic stenosis; leaves open safety and efficacy confirmation in randomized trials.
Transcatheter aortic valve replacement (TAVR) is well-established for severe symptomatic aortic stenosis (AS), but its use in rheumatic heart disease (RHD) has been limited. We systematically review the use of TAVR for severe symptomatic AS in RHD. Pubmed, Embase, and Scopus were searched for TAVR for symptomatic severe AS and proven or suspected RHD. Procedure characteristics, efficacy, and safety endpoints were collected and all definitions were based on the Valve Academic Research Consortium-2 (VARC-2) criteria. We included 3 case series and 12 case reports, with a total of 43 patients. Mean age was 76 years, 75% were female, and 85% had NYHA class III-IV symptoms. Follow up ranged from 1 to 29 months. Patients were moderate to high risk, with Society of Thoracic Surgery score ranging from 6.1% to 17.6%. The approach was transfemoral in 30 (83%) cases. Procedural success occurred in 37 (86%) patients. Of the 7 patients with periprocedural complications, 4 had valve dislodgement, 1 deployment failure, 1 unplanned cardiopulmonary bypass, and 1 moderate aortic regurgitation. Paravalvular leak was reported in 5 (11.6%) patients. Only 1 patient had heart block requiring pacemaker. Among 13 studies (23 patients), 30-day mortality was 0%. One case series with 19 patients had a 30-day, 1-year, 2-year, and 5-year mortality of 5%, 11%, 31%, and 48%, respectively. TAVR appears feasible for selected patients with rheumatic severe AS, albeit our results indicate a 14% incidence of device failure. Future randomized clinical trials may clarify the role of TAVR in this group.
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Fernandes et al. (2021) conducted a systematic review in Severe symptomatic aortic stenosis in rheumatic heart disease (n=43). Transcatheter aortic valve replacement (TAVR) was evaluated on Procedural success. Transcatheter aortic valve replacement in patients with rheumatic severe aortic stenosis achieved an 86% procedural success rate, with a 14% incidence of device failure.
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