Transcatheter Aortic Valve Replacement for Pure Native Aortic Valve Regurgitation The PANTHEON International Project

BACKGROUND Transcatheter aortic valve replacement (TAVR) in patients with pure severe native aortic valve regurgitation (NAVR) has been associated with suboptimal results. The available evidence concerns mostly outdated transcatheter heart valves (THVs). OBJECTIVES The aim of this study was to investigate the performance of new-generation THVs in patients treated for pure severe NAVR. METHODS The PANTHEON (Performance of Currently Available Transcatheter Aortic Valve Platforms in Inoperable Patients With Pure Aortic Regurgitation of a Native Valve) study retrospectively included patients who underwent TAVR with currently available devices (both self-expanding [SE] and balloon expandable [BE]) for severe NAVR. Technical and device success rates as well as a composite of all-cause mortality and heart failure rehospitalization at 1 year were evaluated. The rate and clinical consequences of acute transcatheter valve embolization or migration (TVEM) were also considered.RESULTS A total of 201 patients were included. Overall technical and device success rates were 83.6% and 76.1%, respectively, and did not differ between SE and BE devices. These figures were due mostly to TVEM occurrence (14.6% vs 16.1%; P 1/4 0.47) and residual moderate or greater aortic regurgitation (9.2% vs 10.1%; P 1/4 0.87). Patients who experienced TVEM compared with those without TVEM had a significantly higher incidence of the composite endpoint at 1 year (25.7% vs 15.8%; P 1/4 0.05).CONCLUSIONS Despite improved THV platforms and techniques, TAVR for pure severe NAVR remains a challenging procedure, with significant risk for TVEM. SE and BE platforms demonstrated comparable performance in this setting. (Performance of Currently Available Transcatheter Aortic Valve Platforms in Inoperable Patients With Pure Aortic Regurgitation of a Native Valve [PANTHEON]; NCT05319171) (J Am Coll Cardiol Intv 2023;16:1974-1985)& COPY; 2023 by the American College of Cardiology Foundation.

Automated summary

This study investigated the performance of new-generation transcatheter heart valves (THVs) in patients treated for pure severe native aortic valve regurgitation (NAVR). The results showed that TAVR for pure severe NAVR remains challenging with significant risk for complications.