Premium
Short‐term outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation in the United States
Author(s) -
Isogai Toshiaki,
Saad Anas M.,
Ahuja Keerat R.,
Shekhar Shashank,
Abdelfattah Omar M.,
Gad Mohamed M.,
Svensson Lars G.,
Krishnaswamy Amar,
Kapadia Samir R.
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29189
Subject(s) - medicine , odds ratio , cardiology , aortic valve replacement , valve replacement , acute kidney injury , confidence interval , stenosis , regurgitation (circulation) , aortic valve stenosis , aortic valve , incidence (geometry) , surgery , physics , optics
Objective We aimed to compare short‐term outcomes between transcatheter aortic valve replacement (TAVR) for pure aortic regurgitation (AR) and TAVR for aortic stenosis (AS). Background In patients with severe pure AR for whom surgical valve replacement is infeasible, TAVR is sometimes used off‐label. Methods Using the Nationwide Readmissions Database 2016–2017, we retrospectively identified patients without prior valve surgery who underwent endovascular TAVR. We compared in‐hospital and 30‐day outcomes according to the type of aortic valve disease. Results A total of 81,542 eligible patients were divided into the pure AR ( n = 1,222, 1.50%), pure AS ( n = 72,690, 89.1%), and AS + AR ( n = 7,630, 9.36%) groups. In unadjusted analyses, the pure AR group, compared with the pure AS and AS + AR groups, showed a higher incidence of acute kidney injury (16.8% vs. 9.8% vs. 12.1%, respectively; p < .001) and need of surgical bailout (1.4% vs. 0.4% vs. 0.6%; p < .01). The pure AR group also showed higher in‐hospital mortality than the pure AS group (2.4% vs. 1.4%; p = .005). After multivariable adjustment, TAVR for pure AR was significantly associated with a higher risk of acute kidney injury (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.33–2.02; p < .001), cardiac tamponade (OR = 1.98, 95% CI = 1.00–3.92; p = .0498), and prolonged hospital stay (OR = 1.59, 95% CI = 1.29–1.95; p < .001) compared with TAVR for pure AS, whereas it was not significantly associated with in‐hospital mortality (OR = 1.55, 95% CI = 0.99–2.45; p = .058) and other outcomes. Conclusions TAVR may be a reasonable treatment option for selected patients with pure AR with regard to short‐term outcomes. However, additional techniques or devices may be necessary to reduce periprocedural risk.