Transcatheter Aortic Valve Replacement for Aortic Regurgitation in Patients with Left Ventricular Assist Devices: An Institutional Experience

Abstract

Background

Aortic regurgitation (AR) is a common complication in patients with left ventricular assist devices (LVAD). However, there is paucity of data regarding the feasibility and safety of transcatheter aortic valve replacement (TAVR) in this population. Hence, we sought to describe the clinical characteristics and outcomes of patients with LVAD and AR who underwent treatment with TAVR at our institution.

Methods

We included all patients with a LVAD who developed clinically significant AR and received TAVR at The Christ Hospital in Cincinnati, Ohio. Baseline clinical and echocardiographic characteristics were collected, and outcomes were defined using Valve Academic Research Consortium 3 criteria.

Results

A total of 7 patients with LVAD were included. The median time from LVAD implantation to TAVR was 3.67 years (IQR, 1.96-4.26 years). The mean age of the patients was 68.6 ± 13.7 years, and the average Society of Thoracic Surgeons score was 6.2 ± 5.2. All patients presented with moderate to severe AR and New York Heart Association functional class III or IV symptoms. All procedures were performed via transfemoral access, with a median procedure time of 149 minutes (IQR, 146-150 minutes). The transcatheter heart valves implanted included commercially available devices—Abbott Navitor (n = 2) and Medtronic Evolut (n = 3)—and dedicated investigational devices for AR—JenaValve Trilogy (n = 1) and J-Valve (n = 1). All patients were discharged alive with no or mild residual AR. There was 1 case of device embolization, which was treated with a second valve, and 1 valve migration treated with snaring and repositioning of the valve. Both complications occurred in patients treated with commercially available self-expanding valves.

Conclusions

TAVR for AR in selected patients with LVAD is a feasible therapeutic option that may improve outcomes. Larger studies are necessary to better define procedural risks, optimal patient selection, and the role of TAVR valves specifically designed for AR in this population.