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TAVI in Pure Aortic Insufficiency: Our Case Series
Session:
SESSÃO DE POSTERS 34 - TAVI 2
Speaker:
Francisco Rocha Cardoso
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Francisco Rocha Cardoso; Francisco Albuquerque; Mariana Coelho; Fernando Ferreira; Miguel Figueiredo; Inês Rodrigues; André Grazina; Tiago Mendonça; Rúben Ramos; António Fiarresga; Rui C Ferreira; Duarte Cacela
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Introduction:</span></strong><br /> <span style="font-size:10.0pt">Transcatheter Aortic Valve Implantation (TAVI) is widely used for the treatment of aortic stenosis in high-risk surgical patients. Recently, its off-label use for moderate to severe pure aortic insufficiency (AI) has been explored as an alternative in patients deemed inoperable or with contraindications to conventional surgery. This study analyses our clinical experience with TAVI for moderate to severe pure AI, highlighting the technical challenges associated with this procedure.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Methods:</span></strong><br /> <span style="font-size:10.0pt">We retrospectively analysed 7 patients who underwent TAVI for moderate to severe pure AI at a central hospital in Portugal. Baseline characteristics, complications, and clinical outcomes at 30 days and 12 months were assessed. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Results:</span></strong><br /> <span style="font-size:10.0pt">The mean age was 79 years, with a predominance of male patients (57%). The mean STS score was 4.3. Five patients had chronic renal failure, three atrial fibrillation, and three had a history of coronary artery disease. The procedure was technically successful in 57% of cases. Complications included three cases of valve malposition: one migration into the left ventricle and two embolization to a supra-annular position with subsequent ectopic implantation and required a second valve during the procedure. In one patient no valve was implanted and needed an urgent surgical aortic valve replacement (SAVR) due to rapid clinical deterioration after TAVI attempt. Vascular complications occurred in 29% of cases (one major, one minor). There were no reported cerebrovascular events. Two patients experienced major bleeding, and two developed acute kidney injury. In-hospital mortality was 14%, while overall mortality at 12 months was 29%.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Discussion:</span></strong><br /> <span style="font-size:10.0pt">TAVI implantation in pure AI presents significant technical challenges. The absence of calcification in the annulus reduces prosthesis anchoring, increasing the risk of migration and malposition. Additionally, the frequent dilation of the aortic root and ascending aorta in these patients complicates device stabilization, while the elliptical geometry of the annulus and severe regurgitant flow further challenge accurate positioning. These challenges explain the occurrence of complications such as valve migration, the need for a second valve, and conversion to open surgery. Despite these technical difficulties, our results align with previous studies confirming the feasibility of the procedure in carefully selected patients.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Conclusion:</span></strong><br /> <span style="font-size:10.0pt">TAVI represents a promising alternative for patients with moderate to severe AI who are not candidates for conventional surgery. However, the inherent technical challenges of the implantation, including anchoring difficulties and vascular complications, underscore the need for technological advancements, meticulous planning, and technical expertise to optimize outcomes.</span></span></span></p>
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