Transcatheter aortic valve replacement for aortic regurgitation: a case report_West China Medical Journal

Authors：

ZHU Jiajun , ZHAO Qian , CHEN Qingjie , ZHAO Long ,  YANG Yining

Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P. R. China;

Corresponding author：

YANG Yining, Email: yangyn5126@163.com

Keywords：

Aortic regurgitation; Transcatheter aortic valve replacement; Prosthetic valve

DOI：

10.7507/1002-0179.202003026

Video：

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Severe symptomatic native aortic regurgitation (AR) is associated with poor prognosis. Surgical aortic valve replacement is presently the main choice of treatment according to current guidelines. The data of safety and efficacy of transcatheter aortic valve replacement (TAVR) for patients with pure native AR were limited. In this paper, a case of AR patient with heart failure was reported. After preoperative CT evaluation and operation plan, the postoperative symptoms improved significantly. Bundle branch block and retroperitoneal hematoma appeared during hospitalization. After the treatment, the patient’s condition improved. Before the discharge, cardiac ultrasound indicated that the reflux was significantly improved, no perivalvular leakage was observed, and cardiac function was improved. AR remains a challenging pathology for TAVR. TAVR is a feasible and reasonable option for carefully selected patients with pure AR.

Citation： ZHU Jiajun, ZHAO Qian, CHEN Qingjie, ZHAO Long, YANG Yining. Transcatheter aortic valve replacement for aortic regurgitation: a case report. West China Medical Journal, 2020, 35(4): 454-458. doi: 10.7507/1002-0179.202003026 Copy

1.	Blanke P, Weir-McCall JR, Achenbach S, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the society of cardiovascular computed tomography. JACC Cardiovasc Imaging, 2019, 12(1): 1-24.
2.	Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation, 1999, 99(14): 1851-1857.
3.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Rev Esp Cardiol (Engl Ed), 2018, 71(2): 110.
4.	Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J, 2003, 24(13): 1231-1243.
5.	von Scheidt W, Welz A, Pauschinger M, et al. Interdisciplinary consensus on indications for transfemoral transcatheter aortic valve implantation (TF-TAVI): joint consensus document of the arbeitsgemeinschaft leitende kardiologische krankenhausärzte e. V. (ALKK) and cooperating cardiac surgery departments. Clin Res Cardiol, 2020, 109(1): 1-12.
6.	中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
7.	中国医师协会主动脉瓣膜腔内微创治疗专家委员会. 主动脉瓣狭窄微创腔内治疗专家共识. 中华胸心血管外科杂志, 2016, 32(9): 513-521.
8.	Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation, 2005, 112(1): 125-134.
9.	Hildebrandt HA, Erbel R, Kahlert P. Compassionate use of the self-expandable medtronic coreValve prosthesis for the treatment of pure aortic regurgitation in a patient at prohibitive risk for surgical valve replacement. Catheter Cardiovasc Interv, 2013, 82(7): E939-943.
10.	Jiang J, Liu X, He Y, et al. Transcatheter aortic valve replacement for pure native aortic valve regurgitation: a systematic review. Cardiology, 2018, 141(3): 132-140.
11.	Seiffert M, Bader R, Kappert U, et al. Initial german experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv, 2014, 7(10): 1168-1174.
12.	Schofer J, Nietlispach F, Bijuklic K, et al. Transfemoral implantation of a fully repositionable and retrievable transcatheter valve for noncalcified pure aortic regurgitation. JACC Cardiovasc Interv, 2015, 8(14): 1842-1849.
13.	Urena M, Himbert D, Ohlmann P, et al. Transcatheter aortic valve replacement to treat pure aortic regurgitation on noncalcified native valves. J Am Coll Cardiol, 2016, 68(15): 1705-1706.
14.	Wendt D, Kahlert P, Pasa S, et al. Transapical transcatheter aortic valve for severe aortic regurgitation: expanding the limits. JACC Cardiovasc Interv, 2014, 7(10): 1159-1167.
15.	Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
16.	Seiffert M, Diemert P, Koschyk D, et al. Transapical implantation of a second-generation transcatheter heart valve in patients with noncalcified aortic regurgitation. JACC Cardiovasc Interv, 2013, 6(6): 590-597.
17.	Schlingloff F, Schäfer U, Frerker C, et al. Transcatheter aortic valve implantation of a second-generation valve for pure aortic regurgitation: procedural outcome, haemodynamic data and follow-up. Interact Cardiovasc Thorac Surg, 2014, 19(3): 388-393.
18.	Haddad A, Arwani R, Altayar O, et al. Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation: a systematic review and meta-analysis. Clin Cardiol, 2019, 42(1): 159-166.
19.	Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
20.	Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience. Eur Heart J, 2014, 35(24): 1599-1607.
21.	Poels TT, Houthuizen P, Van Garsse LA, et al. Frequency and prognosis of new bundle branch block induced by surgical aortic valve replacement. Eur J Cardiothoracic Surg, 2015, 47(2): e47-e53.
22.	Kawashima T, Sato F. Visualizing anatomical evidences on atrioventricular conduction system for TAVI. Int J Cardiol, 2014, 174(1): 1-6.
23.	Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U. S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv, 2016, 9(21): 2189-2199.
24.	Chamandi C, Barbanti M, Munoz-Garcia A, et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR. JACC Cardiovasc Interv, 2019, 12(12): 1175-1184.

1. Blanke P, Weir-McCall JR, Achenbach S, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the society of cardiovascular computed tomography. JACC Cardiovasc Imaging, 2019, 12(1): 1-24.
2. Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation, 1999, 99(14): 1851-1857.
3. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Rev Esp Cardiol (Engl Ed), 2018, 71(2): 110.
4. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J, 2003, 24(13): 1231-1243.
5. von Scheidt W, Welz A, Pauschinger M, et al. Interdisciplinary consensus on indications for transfemoral transcatheter aortic valve implantation (TF-TAVI): joint consensus document of the arbeitsgemeinschaft leitende kardiologische krankenhausärzte e. V. (ALKK) and cooperating cardiac surgery departments. Clin Res Cardiol, 2020, 109(1): 1-12.
6. 中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
7. 中国医师协会主动脉瓣膜腔内微创治疗专家委员会. 主动脉瓣狭窄微创腔内治疗专家共识. 中华胸心血管外科杂志, 2016, 32(9): 513-521.
8. Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation, 2005, 112(1): 125-134.
9. Hildebrandt HA, Erbel R, Kahlert P. Compassionate use of the self-expandable medtronic coreValve prosthesis for the treatment of pure aortic regurgitation in a patient at prohibitive risk for surgical valve replacement. Catheter Cardiovasc Interv, 2013, 82(7): E939-943.
10. Jiang J, Liu X, He Y, et al. Transcatheter aortic valve replacement for pure native aortic valve regurgitation: a systematic review. Cardiology, 2018, 141(3): 132-140.
11. Seiffert M, Bader R, Kappert U, et al. Initial german experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv, 2014, 7(10): 1168-1174.
12. Schofer J, Nietlispach F, Bijuklic K, et al. Transfemoral implantation of a fully repositionable and retrievable transcatheter valve for noncalcified pure aortic regurgitation. JACC Cardiovasc Interv, 2015, 8(14): 1842-1849.
13. Urena M, Himbert D, Ohlmann P, et al. Transcatheter aortic valve replacement to treat pure aortic regurgitation on noncalcified native valves. J Am Coll Cardiol, 2016, 68(15): 1705-1706.
14. Wendt D, Kahlert P, Pasa S, et al. Transapical transcatheter aortic valve for severe aortic regurgitation: expanding the limits. JACC Cardiovasc Interv, 2014, 7(10): 1159-1167.
15. Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
16. Seiffert M, Diemert P, Koschyk D, et al. Transapical implantation of a second-generation transcatheter heart valve in patients with noncalcified aortic regurgitation. JACC Cardiovasc Interv, 2013, 6(6): 590-597.
17. Schlingloff F, Schäfer U, Frerker C, et al. Transcatheter aortic valve implantation of a second-generation valve for pure aortic regurgitation: procedural outcome, haemodynamic data and follow-up. Interact Cardiovasc Thorac Surg, 2014, 19(3): 388-393.
18. Haddad A, Arwani R, Altayar O, et al. Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation: a systematic review and meta-analysis. Clin Cardiol, 2019, 42(1): 159-166.
19. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
20. Nazif TM, Williams MR, Hahn RT, et al. Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience. Eur Heart J, 2014, 35(24): 1599-1607.
21. Poels TT, Houthuizen P, Van Garsse LA, et al. Frequency and prognosis of new bundle branch block induced by surgical aortic valve replacement. Eur J Cardiothoracic Surg, 2015, 47(2): e47-e53.
22. Kawashima T, Sato F. Visualizing anatomical evidences on atrioventricular conduction system for TAVI. Int J Cardiol, 2014, 174(1): 1-6.
23. Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U. S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv, 2016, 9(21): 2189-2199.
24. Chamandi C, Barbanti M, Munoz-Garcia A, et al. Long-term outcomes in patients with new-onset persistent left bundle branch block following TAVR. JACC Cardiovasc Interv, 2019, 12(12): 1175-1184.

West China Medical Journal

Transcatheter aortic valve replacement for aortic regurgitation: a case report

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