Transcatheter aortic valve implantation in pure aortic regurgitation: Hemodynamic and echocardiographic findings in bioprosthesis vs. native valve

Abstract

The objective of this study is to compare hemodynamic and echocardiographic findings between valve-in-valve (VIV) and native-valve (NV) patients submitted to transcatheter aortic valve implantation (TAVI) due to pure aortic regurgitation (AR). Patients with severe AR are surgically treated with variable postinterventional left-ventricular (LV) "reverse remodeling."TAVI might be considered in selected AR patients. Twenty-eight patients with pure severe AR caused by either degenerated bioprosthesis or NV disease were successfully treated by TAVI at our institution. LV catheterization before and after TAVI and echocardiography before, after (24-72 h), and at follow-up (3-12 months) were performed. Baseline clinical, hemodynamic, and echocardiographic characteristics were comparable between the two study groups, except for a younger age, higher proto-diastolic LV pressure, and higher LV end-systolic diameter in the NV group.At catheterization, an immediate hemodynamic impact of TAVI in both groups was noticed, with a trend toward better postprocedural residual regurgitation index and significantly lower LV dP/dT values (666.0 ± 177.9 vs.883.5 ± 259.7 mmHg/s, p = 0.04) in VIV.At echocardiography, both NV and VIV patients showed favorable (early and sustained) post-TAVI echocardiographically detectable reverse remodeling. VIV patients also showed more pronounced early reduction in indexed LV end-diastolic volume (68.1 ± 27.4vs. 86.5 ± 28.9 ml/m2 in VIV, p < 0.001and 81.0 ± 29.0vs. 95.2 ± 37.8 ml/m2 in NV, p = 0.043). Successful TAVI induces a striking hemodynamic impact with major structural (reverse remodeling) consequences in patients with pure AR caused by both bioprosthesis degeneration or NV disease. In the immediate postrelease phase, VIV patients might exhibit a more pronounced early LV contractile and structural benefit.