Outcomes of Transcatheter Aortic Valve Replacement for Primary Aortic Regurgitation

Introduction Severe native aortic valve regurgitation (AR) is a common valvular abnormality associated with significant morbidity and mortality. Among high-risk surgical candidates, transcatheter aortic valve replacement (AVR) (TAVR) is increasingly undertaken with a paucity of data on outcomes. Methods Using the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, patients undergoing TAVR for severe AR with ≤mild aortic stenosis between 2012 and 2024 were identified. The primary outcome was technical success. Additional outcomes included 1-year mortality, reintervention, and rehospitalization that are presented as risk ratios derived from the probabilities of events occurring in the technical successful and unsuccessful cohorts. Results Of 1041 individuals with severe AR undergoing TAVR, technical success was achieved in 82.1% of individuals. The only predictor of technical success included STS risk score (odds ratio [OR] 0.85; 95% CI 0.73–0.99 per 5 percentage point increase; p=0.03). Rates of in-hospital mortality and 1-year mortality, aortic valve reintervention, and hospital readmission were 5.8%, 20.8%, 5.0%, and 35.8%, respectively. Technical success was associated with lower 1-year mortality (19.0% vs. 29.0%; risk ratio 0.65; 95% CI 0.47–0.92). Conclusion The use of TAVR in nonsurgical candidates with severe AR is increasing. Due to mortality associated with unsuccessful procedures, efforts to identify anatomical parameters associated with poor outcomes are needed.