Novel valve system confers improved outcomes after TAVR in aortic regurgitation
A novel transcatheter heart valve system may be suitable for patients with noncalcified aortic valve disease who are at risk for coronary obstruction, according to a study published in EuroIntervention.
Mark Hensey, MB, BCh, BAO, of the Centre for Heart Valve Innovation at St. Paul’s Hospital in Vancouver, British Columbia, and colleagues performed transcatheter aortic valve replacement with the transapical approach using a valve system (J-Valve, JC Medical) on a patient who was aged 42 years, had prior subaortic membrane repair and presented with recurrent HF hospitalizations related to aortic regurgitation.
The valve system, which is not recapturable, comprises the valve itself and three U-shaped anchor rings, according to the study.
“First the anchor rings are opened above the native valve and are retracted or advanced into the valve apparatus, allowing automatic anatomic alignment in the aortic sinuses and clasping of the native valve leaflets,” Hensey and colleagues wrote. “Once positioned, the self-expanding valve is then deployed within the anchor rings and secures the native valve leaflets.”
Sizing of the valve system was confirmed through intraoperative transesophageal echocardiography, although it is not required for valve deployment.
Hemodynamics immediately improved after the valve was deployed, and there was no significant aortic regurgitation, as confirmed by aortography and echocardiography.
The aortic portion of the valve frame was under-expanded, which may have been related to the rotation of the delivery system after the anchor rings were deployed, according to the study.
The patient was intubated for 8 days for required temporary intermittent hemodialysis and high respiratory support requirements.
Once discharged, the patient had improved renal function, was euvolemic, had NYHA class II symptoms and did not require diuretics.
At 30 days, the patient maintained NYHA class II status and continued to not require diuretics. The patient also had normal left ventricular systolic function, did not have aortic regurgitation and had a mean gradient of 18 mm Hg.
“A [transfemoral] approach is less invasive than [transapical] access whilst preserving the leaflet-securing and anatomic positioning abilities of the J-Valve system,” Hensey and colleagues wrote. “These leaflet-securing properties offer possible advantages, not only in the treatment of pure [aortic regurgitation], but also may ... offer a solution to the treatment of patients with either native [aortic stenosis] or bioprosthetic valve failure at high risk of coronary obstruction as the anchor rings may retract the native or bioprosthetic valve leaflets to avoid obstructing the coronary ostia; this requires further investigation.” – by Darlene Dobkowski
Disclosures: Hensey reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.