Transcatheter Aortic Valve Replacement for Structural Valve Deterioration After Aortic Valve Neocuspidization.

Background: Evidence on structural valve deterioration (SVD) after aortic valve neocuspidization (AVNeo) remains limited. While transcatheter aortic valve replacement (TAVR) offers a less invasive option, its feasibility is unclear. This study aimed to characterize SVD patients post-AVNeo and to assess TAVR feasibility.

Methods: This retrospective study included 11 patients who underwent TAVR for SVD after AVNeo in Sendai Kousei Hospital between June 2017 and August 2024. Four patients with aortic stenosis (AS) and seven with aortic regurgitation (AR) due to SVD were included.

Results: AS-SVD group showed shorter time interval from AVNeo to TAVR (50.5 [28.3-98.3] vs. 107.0 [97.0-131.0] months, p = 0.04) and smaller aortic annulus area (316.5 [259.8-375.0] vs. 538.0 [440.0-582.0] mm², p = 0.005) than AR-SVD group. In TAVR, technical success was achieved in 91% of cases. Although coronary obstruction is a concern due to the long leaflet, no case occurred. Misidentification of the basal ring plane caused by the slack cusp resulted in second valve implantation (one case) and new conduction disturbance (two cases) due to deep implantation, and aortic contained rupture (one case) for oversized valve selection.

Conclusions: Rapid AS-SVD progression and AR-SVD occurring later than previously reported were observed, highlighting the need for further studies on AVNeo durability. TAVR after AVNeo was feasible. Special precautions for coronary obstruction may be unnecessary. Careful hinge point placement at the boundary between pericardial cusps and the annulus was a key to CT-based basal ring determination in patients after AVNeo.