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Counterpoint: challenges and limitations of transcatheter aortic valve implantation for aortic regurgitation
  1. Chetan P Huded1,
  2. Keith B Allen2,
  3. Adnan K Chhatriwalla1
  1. 1Department of Cardiology, Saint Luke's Hospital, Kansas City, Missouri, USA
  2. 2Department of Cardiothoracic Surgery, Saint Luke's Hospital, Kansas City, Missouri, USA
  1. Correspondence to Dr Adnan K Chhatriwalla, Saint Luke's Hospital, Kansas City, MO 64111, USA; achhatriwalla{at}saint-lukes.org

Abstract

Transcatheter aortic valve implantation (TAVI) for isolated aortic regurgitation (AR) comprises <1.0% of all TAVI procedures performed in the USA. In this manuscript, we review the challenges, evidence and future directions of TAVI for isolated AR. There are no randomised clinical trials or mid-term data evaluating TAVI for isolated AR, and no commercially available devices are approved for this indication. Challenges in performing TAVI for isolated AR as opposed to aortic stenosis (AS) include: lack of a calcified anchoring zone for valve deployment, large and dynamic size of the aortic annulus and high stroke volume (during systole) and regurgitant volume (during diastole) across the aortic annulus during each cardiac cycle. Observational studies have shown that outcomes of TAVI for AR are worse than outcomes of TAVI for AS. However, newer generation TAVI devices may perform better than older generation devices in patients with AR. Two emerging valves (the JenaValve and the J-Valve) are designed with mechanisms to anchor in a non-calcified annulus, and these valves have shown promise for AR. Data on these devices are limited, and clinical investigation is ongoing. Randomised clinical trials are needed to establish TAVI as a safe and effective treatment for isolated AR.

  • heart valve prosthesis implantation
  • transcatheter aortic valve replacement
  • aortic valve insufficiency

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Footnotes

  • Twitter @akcmahi

  • Contributors CPH contributed to the planning, drafting and revision of this review article. KBA contributed to the planning, drafting and revision of this review article. AC contributed to the planning, drafting and revision of this review article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KBA: Abbott Vascular: Consultant, Research Support, Speakers Bureau; Edwards Lifesciences: Consultant, Research Support, Speakers Bureau; Medtronic Inc: Consultant, Research Support, Speakers Bureau. AC: Abbott Vascular: Speakers Bureau; Boston Scientific: Consultant, Research Grant; Edwards Lifesciences: Proctor, Speakers Bureau; Medtronic Inc: Proctor, Speakers Bureau.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

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