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

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.