Possible Alternative Found for Heart Surgery Patients With High Preoperative Risk

Transcatheter aortic valve replacement (TAVR) is a potential alternative to open-heart surgery in patients with aortic insufficiency and high preoperative risk, according to a recent meta-analysis.

Findings were presented at the National Medical Association 115th Annual Convention and Scientific Assembly, which is taking place in Philadelphia, PA, from July 29-August 2, 2017.
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Left ventricular assist device (LVAD) implantation has increased due to a shortage of donor hearts for transplantation and an increasing population of end-stage heart failure (HF) patients. However, many patients become refractory to the therapy as a result of aortic insufficiency from aortic root dilation and myxoid degeneration of the aortic valve.

The only previously available treatment for this was open-heart surgery with valve replacement. However, many of these patients are deemed high-risk for the surgery due to comorbidities. Less is known about TAVR as a potential alternative for this patient population.

In the analysis, the researcher evaluated 10 publications through 2016 that detailed the cases of 10 patients with aortic insufficiency after receiving LVAD. A total of 30% of patients were women, and mean patient age was 59.3 years. Mean time from LVAD insertion to onset of severe symptomatic aortic insufficiency was 18 months. A total of 78% of patients had nonischemic cardiomyopathy, and 22% had ischemic cardiomyopathy.

A total of 80% of patients received a Heart Mate II LVAD implantation. TAVR was performed among patients, with 50% receiving the core valve, 30% receiving the Edwards valve, and 20% receiving the Melody valve.

Results indicated that 7 (70%) patients achieved device success. The researcher noted that success increased to 90% after 2 patients received a second valve for residual aortic regurgitation or malposition during the index procedure.

According to the researcher, there was no in-hospital mortality, and 30-day mortality was 0% in all successfully discharged patients. Available survival data on 4 patients indicated that patient survival ranged from 15 days to 10 months. No patients required a permanent pacemaker. Additionally, 67% of patients had no aortic insufficiency following TAVR, while 33% had Grade I and Grade II aortic insufficiency. None had moderate or severe aortic insufficiency following TAVR.

“In patients with a prohibitively high reoperative risk, TAVR is a feasible alternative to valve surgical procedures,” the researcher concluded. “And shows good survival and low complication rate. However, larger studies are needed to validate our results.”

—Christina Vogt

Reference:

Bob-Manuel T. Outcomes following transcatheter aortic valve replacement in patients who develop severe aortic regurgitation following left ventricular assist device implantation: a detailed case series. Paper presented at: National Medical Association 2017 Annual Convention and Scientific Assembly; July 29-August 2, 2017. Philadelphia, PA. http://abcardio.org/wp-content/uploads/2017/02/Abstract-20.pdf.