INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

TRANSCATHETER AORTIC VALVE IMPLANTATION IN PURE AORTIC INSUFFICIENCY

Serkan Bulguroğlu

Hatay Dörtyol State Hospital, Department of Cardiology, Hatay, Türkiye

Bulguroğlu S. Transcatheter Aortic Valve Implantation in Pure Aortic Insufficienc. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.305-314.

ABSTRACT

Transcatheter aortic valve implantation (TAVI) has emerged as a pivotal advancement in managing valvular heart diseases. Initially developed for severe aortic stenosis in high-risk or inoperable patients, its application has expanded to include intermediate and low-risk groups. However, its use in pure aortic insufficiency is not included in the guidelines due to technical issues such as valve positioning, since there is no calcification, and because the long-term outcomes are unknown. This review explores the evolving role of TAVI in treating pure aortic regurgitation (AR), highlighting the associated technical difficulties, device advancements, and clinical outcomes.

Pure AR, a progressive condition caused by inadequate valve closure, often leads to left ventricular dilatation and heart failure. Surgical intervention is the guideline-recommended standard; however, many patients with severe AR and comorbidities are deemed unsuitable for surgery. TAVI, despite its challenges in this subset, offers a minimally invasive alternative. Early-generation devices faced significant limitations, but next-generation valves, such as the JenaValve and ACURATE TA, have shown improved procedural success and safety profiles.

Clinical studies and registry data reveal promising outcomes for TAVI in AR, including reduced mortality and fewer complications like stroke and major bleeding compared to surgical aortic valve replacement (SAVR). Dedicated devices specifically designed for non-calcified valves, such as the JenaValve Trilogy, have demonstrated high success rates and favorable hemodynamic performance. Key considerations include precise imaging for valve sizing and implantation techniques to minimize risks like paravalvular leak and device migration.

In conclusion, while surgery remains the primary treatment for severe AR, TAVI is becoming an increasingly viable option, particularly for high-risk or inoperable patients. Ongoing advancements in device technology and procedural strategies are expected to further enhance outcomes and may influence future guideline recommendations. Randomized controlled trials are essential to establish longterm efficacy and safety.

Keywords: Transcatheter aortic valve implantation; Valvular heart disease; Aortic regurtitation

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