Self-Expanding Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation With Extremely Horizontal Aorta: A Case Series

J INVASIVE CARDIOL 2022;34(3):E257-E258.

Key words: horizontal aorta, pure aortic regurgitation, transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) is not the preferred therapy for pure aortic regurgitation (AR). Extremely horizontal aorta (aorta root angle ≥70°) is regarded as an “off-label” use in self-expanding TAVR. This case series enrolled 7 consecutive pure AR patients who had extremely horizontal aorta and underwent self-expanding TAVR from the TORCH registry (NCT02803294). The mean age was 74.1 ± 8.3 years and the Society of Thoracic Surgeons (STS) score was 3.8 ± 1.5%. All patients lacked calcification at the aortic root. Transapical TAVR with a J-valve (Jiecheng) was performed in 5 patients and transfemoral TAVR with a Venus-A valve (Medtech) was performed in 2 patients (Figure 1 Part 1 and Figure 1 Part 2).

Case 1 received permanent pacemaker implantation and suffered a non-disabling stroke, while case 4 and case 5 suffered major bleeding during 30-day follow-up. Detailed aortic angulation measurement and fluoroscopy during the procedure are shown in Figure 1 Part 1 and Figure 1 Part 2. Nevertheless, procedural success was achieved in all patients according to Valve Academic Research Consortium-2 definitions and no patients were at New York Heart Association class III/IV at 30 days. To the best of our knowledge, this is the first study to report successful self-expanding TAVR for pure AR with extremely horizontal aorta, revealing the feasibility of both transapical and transfemoral TAVR in this challenging population.

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