Off-Label Use of Balloon-Expandable Transcatheter Valves to Treat Pure Aortic Regurgitation

Abstract

Transcatheter aortic valve implantation (TAVI) in native pure aortic regurgitation (AR) with off-label use of balloon expandable valves (BEV) has been reported. However, there are scant data regarding optimal oversizing and its safety and our study assessed BEV oversizing and outcomes of TAVI. Thirteen consecutive tricuspid aortic valve patients undergoing transfemoral TAVIs for pure AR with Sapien BEV at our centre between 2019 and 2023 (69.2% males, mean age 80.8 years, STS 4.0%) were divided into small annulus group (≤618mm2, SA) where ≥20% oversizing is achievable based on published data on BEV overexpansion, and larger annulus group (LA, >618mm2). Overexpansion and actual oversizing were measured on post-procedural CT scan. Technical success was 92.3% with one valve embolization in LA group. The post-procedural CT showed a mean 28.3% oversizing, significantly higher in SA (31.2%) then in LA group (19.4%), p= 0.0092. Oversizing ≥20% was achieved in 100% SA vs 33.3% LA patients (p=0.046). In conclusion, TAVI in pure AR with oversized Sapien BEV showed good procedural and short-term outcomes when ≥20% oversizing was predictably achievable.