TAVR Shows Promise for Aortic Regurgitation in a Cohort of US Patients

In a study, researchers examined outcomes of transcatheter aortic valve replacement (TAVR) in patients with aortic regurgitation in the United States. These findings were published in Catheterization & Cardiovascular Interventions.

The authors wrote, “TAVR can be an effective option for high-risk [patients with] aortic regurgitation. Although international experiences of TAVR for aortic regurgitation are published, US data are limited. This study sought to report the short-term outcomes of TAVR in aortic regurgitation in the US.”

To identify the study cohorts, the investigators queried the Nationwide Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) from 2016 through 2017 to identify cases of TAVR for aortic regurgitation. The primary outcomes were all-cause mortality, disabling stroke, valvular complications, complete heart block/permanent pacemaker placement, open-heart surgery, acute kidney injury requiring dialysis, and vascular complications. The team conducted multivariate logistic regression to determine potential confounders.

In total, 915 patients were identified from the NIS, comprising 71% males, primarily (84.2%) aged ≥65 years. From the NRD, 822 patients were identified (69.3% male and 80.5% patients aged ≥65 years).

For both cohorts, the median length of stay was four days, the in-hospital mortality rate was 2.7%, and the 30-day mortality rate was 3.3%. Regarding disabling strokes, 0.6% of cases occurred perioperatively and 1.8% occurred at 30 days. The rate of valve-related complications was around 19.0%, and the most common complication was paravalvular leak, which occurred in between 4.0% to 7.0% of patients. Overall, 11% of patients developed complete heart block and/or needed permanent pacemaker placement.

In the NRD cohort specifically, 2.2% of patients required dialysis for acute kidney injury, 1.5% reported vascular complications, and 0.6% required open-heart surgery within 30-days postoperatively.

Anemia was the only identified predictor of increased overall and valvular complications. Peripheral vascular disease was predictive for greater valvular complications and complete heart block/permanent pacemaker.

“TAVR is a promising option in aortic regurgitation,” the researchers concluded. “Further studies are necessary for the expansion of TAVR as the standard treatment in aortic regurgitation.”