Tavi in Patients with Aortic Regurgitation, Native and Redo. Special Issues to Address?
Gry Dahle, Jon Offstad, Lars Aaberge, Christian Eek, Anders Hervold, Jan Otto Beitnes, Thomas Helle-Valle, Kjell Arne Rein.
Rikshospitalet, OUS, Oslo, Norway.
Objective Aortic regurgitation (AR) occurs more often in younger patients than aortic stenosis (AS). Repair must be considered. Indication for treatment more vague than for AS and patients may develop heart failure because of ventricular dilatation. AR occur in native aortic valves or following surgery : David repair, A-dissection, degenerated homograft or bioprosteses (stented and stentless). TAVI as treatment is still an issue of discussion. We present a single center material of 15 patients treated for AR. Method CT reconstruction was done for procedural planning. All but one procedures were performed in general anesthesia, fluoroscopy/angiography and transoesophagel guidance. Transapical approach was done in 87%. Special designed cathetervalves with “arms”/”feelers” or stabilizing arches were implanted in 66%. For the rest balloon expandable valves were used. Material Fifteen patients, seven women , mean age 59 (27-87) years were treated. Three had implantation in native aortic valve, seven in xenograft, three in homograft, two following supracoronary graft for A-dissection and one extraanatomical in Rastelli channel. Implant success was 93%. Two patients needed a second valve. At follow up (1-5 years) 87% were free from PVL > grade 0.5. None had coronary obstruction, new pacemaker or embolized valve. One patient died before 30d and total survival was 73%. One patient had redo surgery due to valve degeneration and MR. See table 1. Conclusion TAVI in AR is challenging but feasible. The patients with AR are younger and differ from patients with aortic stenosis, hence durability has to be addressed, and in native valve repair to be considered in stead of replacement. TAVI in AR as redo can be considered in high risk patients. The challenges are how much to oversize, lack of radiopaque markers for landmark and calcium to keep the valve in place. 
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