Transapical implantation of a second-generation transcatheter heart valve in patients with noncalcified aortic regurgitation.

JACC. Cardiovascular interventions

PubMedID: 23683735

Seiffert M, Diemert P, Koschyk D, Schirmer J, Conradi L, Schnabel R, Blankenberg S, Reichenspurner H, Baldus S, Treede H. Transapical implantation of a second-generation transcatheter heart valve in patients with noncalcified aortic regurgitation. JACC Cardiovasc Interv. 2013;6(6):590-7.
OBJECTIVES
This study sought to report on the feasibility and early results of transcatheter aortic valve implantation employing a second-generation device in a series of patients with pure aortic regurgitation.

BACKGROUND
Efficacy and safety of transcatheter aortic valve implantation in patients with calcific aortic stenosis and high surgical risk has been demonstrated. However, experience with implantation for severe noncalcified aortic regurgitation has been limited due to increased risk for valve dislocation or annular rupture.

METHODS
Five patients (mean age: 66.6 ± 7 years) underwent transapical implantation of a JenaValve (JenaValve Technology GmbH, Munich, Germany) transcatheter heart valve for moderate to severe, noncalcified aortic regurgitation. All patients were considered high risk for surgical aortic valve replacement after evaluation by an interdisciplinary heart team (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation] range 3.1% to 38.9%). Procedural and acute clinical outcomes were analyzed.

RESULTS
Implantation was successful in all cases without relevant remaining aortic regurgitation or signs of stenosis in any of the patients. No major device- or procedure-related adverse events occurred and all 5 patients were alive with improved exercise tolerance at 3-month follow-up.

CONCLUSIONS
Noncalcified aortic regurgitation continues to be a challenging pathology for transcatheter aortic valve implantation due to the risk for insufficient anchoring of the valve stent within the aortic annulus. This report provides first evidence that the JenaValve prosthesis may be a reasonable option in these specific patients due to its unique stent design, clipping the native aortic valve leaflets, and offering promising early results.