Noncoronary Sinus Pivot Implantation for Transcatheter Aortic Valve Replacement With Self-Expanding Valve for Aortic Regurgitation.

Abstract

Background: Our initial study suggested that patients undergoing transcatheter aortic valve replacement (TAVR) with a self-expanding valve for pure native aortic regurgitation (PNAR) had a lower rate of major adverse cardiac events (MACE) when the noncoronary sinus pivot implantation (NCPI) was achieved.

Objectives: This study enrolled patients with PNAR who underwent TAVR with self-expanding valves between January 2019 and April 2024, compared the NCPI strategy with the conventional approach, and analyzed factors associated with successful NCPI.

Methods: We divided 87 patients into an early (conventional) group of patients treated before February 2023 and a late (NCPI strategy) group of patients treated after February 2023. Then the patients were also categorized by successful NCPI and non-NCPI group.

Results: The late group had significantly higher device success rates than the early group (92.9% vs 73.3%; P = 0.016) and lower rates of MACE (19.5% vs 51.1%; P = 0.002) and valve-in-valve implantation (4.8% vs 24.4%; P = 0.01). Importantly, NCPI was achieved in 90.5% of patients in the late group compared with only 17.8% in the early group (P < 0.001). The NCPI group had a higher device success rate (93.5% vs 70.7%; P = 0.005) and lower MACE rate (17.4%vs 56.1%; P < 0.001) than the non-NCPI group. NCPI (OR: 6.71; P = 0.032) and aortic angulation (OR: 1.07; P = 0.035) were independent predictors of device success.

Conclusions: NCPI strategy could be a general method used in TAVR with a self-expanding valve for patients with PNAR, which had a higher device success rate and lower rate of complications than the conventional method.