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Comment
. 2022 Dec;39(12):1571-1580.
doi: 10.1111/echo.15490. Epub 2022 Nov 14.

A novel anatomic classification to guide transcatheter aortic valve replacement for pure aortic regurgitation

Yang Chen  1 , Zhi-Nan Lu  2 , Jing Yao  2 , Mo-Yang Wang  1 , Guan-Nan Niu  1 , Hong-Liang Zhang  1 , Qing-Rong Liu  1 , Jie Zhao  1 , Zhen-Yan Zhao  1 , Nils Perrin  3   4 , Thomas Modine  5 , Yong-Jian Wu  1 , Guang-Yuan Song  2
Affiliations
Comment

A novel anatomic classification to guide transcatheter aortic valve replacement for pure aortic regurgitation

Yang Chen et al. Echocardiography. 2022 Dec.

Abstract

Background: The success of transcatheter aortic valve replacement (TAVR) in native aortic regurgitation (AR) is limited by the absence of calcified anchoring structures. We sought to evaluate transfemoral TAVR in patients with native AR using a novel aortic root imaging classification.

Methods: From March to November 2021, 81 patients with severe AR were prospectively enrolled in 2 cardiac centers in China. All were evaluated using multidetector computed tomography (MDCT) and classified into 4 anatomic types in reference to transcatheter heart valve (THV) anchoring: Type 1: anchoring at the left ventricular outflow tract (LVOT), annulus, and ascending aorta (AA); Type 2: anchoring at the annulus and AA; Type 3: anchoring at the annulus and LVOT; and Type 4: anchoring at only 1 level or none at all. Based on the dual-anchoring strategy, patients with Types 1-3 were considered TAVR candidates. Procedural and 30-day outcomes were assessed according to Valve Academic Research Consortium-3 definitions.

Results: TAVR was performed in 32 (39.5%) patients (71.9 ± 8.0 years of age, 71.9% were male) using 2 self-expanding THVs. Types 1, 2, and 3 comprised 13 (40.6%), 11 (34.4%), and 8 (25.0%) cases, respectively. The procedural and device success rates were 100% and 93.8%, respectively, with 2 THV migration. Eight patients (25.0%) required a permanent pacemaker, and 2 (6.3%) developed moderate paravalvular leaks. No deaths or other major complications occurred during the study.

Conclusions: The novel anatomic classification and dual-anchoring strategy were associated with a high procedural success rate with favorable short-term safety and clinical outcomes.

Keywords: anatomic classification; dual-anchoring theory; native aortic regurgitation; transcatheter aortic valve replacement.

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References

REFERENCES

    1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. https://doi.org/10.1093/eurheartj/ehab395
    1. Otto CM, Nishimura RA, Bonow RO, et al. ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, J Am Coll Cardiol. 2021;77(2020):e25-e197. ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
    1. Carroll JD, Mack MJ, Vemulapalli S, et al. STS- ACC TVT registry of transcatheter aortic valve replacement, STS-ACC TVT registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020;76:2492-2516. https://doi.org/10.1016/j.jacc.2020.09.595
    1. Yang Y, Wang Z, Chen Z, et al. Current status and etiology of valvular heart disease in China: a population-based survey. BMC Cardiovasc Disord. 2021;21:339. https://doi.org/10.1186/s12872-021-02154-8
    1. 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;24:1231-1243. https://doi.org/10.1016/s0195-668x(03)00201-x

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