Safety and Efficacy of Transcatheter Aortic Valve Replacement in Rheumatic Aortic Regurgitation: A Prospective Cohort Study

Yaojie Wang¹Yu Mao²Yang Liu²Mengen Zhai²Ping Jin²Yazheng Zhang¹Xinbo Liu¹Haibo Zhang¹Hua Zhang¹Youjin Li^1*Jian Yang^2*

• ¹People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
• ²Xijing Hospital of Cardiovascular Surgery, Air Force Medical University, Xi'an, China

Background The prevalence of rheumatic aortic regurgitation (AR) is higher than that of aortic stenosis in developing countries, but the efficacy of transcatheter aortic valve replacement (TAVR) in high surgical risk patients with severe AR remains unknown. Our goal was to explore the differences in clinical outcomes of TAVR in patients with rheumatic and non-rheumatic AR. Methods 144 Rheumatic and 417 nonrheumatic patients with severe AR were prospectively enrolled from January 2018 to December 2021. All patients underwent transapical TAVR with J-Valve after evaluation by computed tomography angiography and transthoracic echocardiography before the procedure. The primary end point was 3-year all-cause mortality. Results The average age was 71.2 [interquartile range (IQR): 66.0–76.0] years, and the Society of Thoracic Surgeons score was 4.8 (IQR: 3.4-6.1) %. The proportion of patients with rheumatic AR who developed ≥ mild PVL was lower than the proportion of patients with non-rheumatic AR (5.6% vs. 11.3%, P < 0.001). At a median follow-up of 39.7 (IQR: 36.4–41.8) months, no difference was observed in the 3-year all-cause mortality (P = 0.740) between the two groups. After multivariate adjustment, the Society of Thoracic Surgeons score, higher frailty and larger aortic angulation were associated with 3-year all-cause mortality. Conclusion For patients with rheumatic AR, the clinical outcomes were similar to those of patients with non-rheumatic AR. TAVR can be one of the feasible treatment options for such patients.