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      TAVI for Pure Native Aortic Regurgitation: Are We There Yet?

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          Abstract

          Treatment of degenerative aortic stenosis has been transformed by transcatheter aortic valve implantation (TAVI) over the past 10–15 years. The success of various technologies has led operators to attempt to broaden the indications, and many patients with native valve aortic regurgitation have been treated ‘off label’ with similar techniques. However, the alterations in the structure of the valve complex in pure native aortic regurgitation are distinct to those in degenerative aortic stenosis, and there are unique challenges to be overcome by percutaneous valves. Nevertheless some promise has been shown with both non-dedicated and dedicated devices. In this article, the authors explore some of these challenges and review the current evidence base for TAVI for aortic regurgitation.

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          A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease.

          Bernard Iung, Gabriel Baron, Eric G Butchart … (2003)
          To identify the characteristics, treatment, and outcomes of contemporary patients with valvular heart disease (VHD) in Europe, and to examine adherence to guidelines. The Euro Heart Survey on VHD was conducted from April to July 2001 in 92 centres from 25 countries; it included prospectively 5001 adults with moderate to severe native VHD, infective endocarditis, or previous valve intervention. VHD was native in 71.9% of patients and 28.1% had had a previous intervention. Mean age was 64+/-14 years. Degenerative aetiologies were the most frequent in aortic VHD and mitral regurgitation while most cases of mitral stenosis were of rheumatic origin. Coronary angiography was used in 85.2% of patients before intervention. Of the 1269 patients who underwent intervention, prosthetic replacement was performed in 99.0% of aortic VHD, percutaneous dilatation in 33.9% of mitral stenosis, and valve repair in 46.5% of mitral regurgitation; 31.7% of patients had > or =1 associated procedure. Of patients with severe, symptomatic, single VHD, 31.8% did not undergo intervention, most frequently because of comorbidities. In asymptomatic patients, accordance with guidelines ranged between 66.0 and 78.5%. Operative mortality was <5% for single VHD. This survey provides unique contemporary data on characteristics and management of patients with VHD. Adherence to guidelines is globally satisfying as regards investigations and interventions.
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            Cellular mechanisms of cardiomyopathy

            Pamela A. Harvey, Leslie Leinwand (2011)
            The heart exhibits remarkable adaptive responses to a wide array of genetic and extrinsic factors to maintain contractile function. When compensatory responses are not sustainable, cardiac dysfunction occurs, leading to cardiomyopathy. The many forms of cardiomyopathy exhibit a set of overlapping phenotypes reflecting the limited range of compensatory responses that the heart can use. These include cardiac hypertrophy, induction of genes normally expressed during development, fibrotic deposits that replace necrotic and apoptotic cardiomyocytes, and metabolic disturbances. The compensatory responses are mediated by signaling pathways that initially serve to maintain normal contractility; however, persistent activation of these pathways leads to cardiac dysfunction. Current research focuses on ways to target these specific pathways therapeutically.
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              Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation

              Sung-Han Yoon, Tobias Schmidt, Sabine Bleiziffer … (2017)
              Article 0 comments Cited 77 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Interv Cardiol
                Journal ID (iso-abbrev): Interv Cardiol
                Journal ID (publisher-id): ICR
                Title: Interventional Cardiology Review
                Publisher: Radcliffe Cardiology
                ISSN (Print): 1756-1477
                ISSN (Electronic): 1756-1485
                Publication date (Print): February 2019
                Volume: 14
                Issue: 1
                Pages: 26-30
                Affiliations
                [1. ] Interventional Cardiology Department, National Institute of Cardiology Ignacio Chávez Mexico City, Mexico
                [2. ] Barts Heart Centre, St Bartholomew’s Hospital London, UK
                [3. ] Cardiology Department, Khoo Teck Puat Hospital Singapore
                Author notes

                Disclosure: The authors have no conflicts of interest to declare.

                Correspondence: Eduardo Arias, National Institute of Cardiology Ignacio Chávez, Juan Badiano 1, Col Sección XVI, Tlalpan, Mexico City, Mexico. E: dreduardoarias@ 123456gmail.com
                Article
                DOI: 10.15420/icr.2018.37.1
                PMC ID: 6406131
                SO-VID: eff2ea62-8f4d-44d3-8ee1-c72820b4f0e8
                Copyright © Copyright © 2019, Radcliffe Cardiology
                License:

                This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.

                History
                Date received : 12 November 2018
                Date accepted : 7 January 2019
                Page count
                Pages: 5
                Categories
                Subject: Structural

                Keywords: aortic valve stenosis,native aortic valve regurgitation,second generation tavi device,tavi,transcatheter valve interventions,valvular heart disease
                Data availability:
                Keywords: aortic valve stenosis, native aortic valve regurgitation, second generation tavi device, tavi, transcatheter valve interventions, valvular heart disease

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