Transcatheter Aortic Valve Replacement for the Treatment of Pure Native Aortic Valve Regurgitation: A Systematic Review.

OBJECTIVES: This study sought to summarize available evidence on transcatheter aortic valve replacement (TAVR) for the treatment of native pure aortic regurgitation (AR).

BACKGROUND: Surgical aortic valve replacement (SAVR) is the gold standard for the treatment of AR. However, case series of high-risk patients undergoing TAVR for native pure AR were reported.

METHODS: We systematically searched Medline, Embase, and Scopus for reports of at least 5 patients with native pure AR undergoing TAVR. Patients' and procedural characteristics were summarized. The primary outcome of interest was all-cause mortality. Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO (CRD42016038422).

RESULTS: Thirteen reports including 237 patients were included in the analysis. Self-expandable prostheses were used in 79% of patients, whereas 21% of the patients were treated with a balloon-expandable valve. Device success ranged between 74% and 100%. Seventeen patients (7%) required the implantation of a second valve. Conversion to SAVR was reported in 6 (2.5%) cases. The rate of all-cause mortality at 30 days amounted to 7% (95% confidence interval [CI]: 3% to 13%; I2  = 37%). Cerebrovascular events were rare (0%, 95% CI: 0% to 1%; I2  = 0); major bleeding and vascular complications occurred in 2% (95% CI: 0% to 7%; I2  = 41%), and 3% (95% CI: 1% to 7%; I2  = 0%), respectively. Permanent pacemaker implantation was required in 11% of patients (95% CI: 5% to 19%; I2  = 50%). The rate of moderate or severe post-procedural AR amounted to 9% (95% CI: 0% to 28%; I2  = 90%).

CONCLUSIONS: Among selected patients with native pure AR deemed at high risk for SAVR, TAVR is technically feasible and associated with an acceptable risk of early mortality.