Study Reports Safety and Efficacy Outcomes of TAVR for Pure Aortic Insufficiency

Transcatheter aortic valve replacement (TAVR) demonstrated similar safety and efficacy outcomes compared to surgery in patients with pure aortic insufficiency (PAI), also referred to as aortic regurgitation, according to a study. These findings were published in Mayo Clinic Proceedings.

“The treatment of choice for patients with severe symptomatic PAI is surgical aortic valve replacement (SAVR),” the authors wrote. “However, not all patients are candidates for surgery because of comorbidities or are deemed high risk for surgery. As a result, TAVR is being used as an off-label procedure in some patients with PAI.”

The investigators utilized the National Inpatient Sample database to identify patients treated for aortic valve insufficiency receiving either TAVR or SAVR between January 2016 and December 2017. Those with concomitant aortic stenosis, with a history of infective endocarditis, and aged younger than 18 years were excluded.

In total, 14,720 patients were included in the final analysis. The rate of TAVR use was 6.2%. The TAVR group tended to be significantly older compared with the SAVR group (median age, 78 vs. 64 years; P<0.001).

The researchers noted comparable rates of in-hospital mortality between techniques. After adjustment for confounders, there was an association between treatment method and risk of complications—including acute kidney injury, cardiogenic shock, postoperative respiratory complications, and length of stay—in favor of TAVR. Patients who underwent SAVR had a reduced likelihood of requiring permanent pacemaker implantation.

“There was no evidence of a significant statistical difference in in-hospital mortality between patients with PAI treated by either SAVR or TAVR, both in unmatched and propensity-matched cohorts,” concluded the researchers. “TAVR could be considered for patients with PAI who are not candidates for surgery.”