# Safety and efficacy of transcatheter aortic valve replacement in rheumatic aortic regurgitation: a prospective cohort study

## TL;DR

This study finds that TAVR is equally safe and effective for treating rheumatic and non-rheumatic aortic regurgitation in high-risk patients.

## Contribution

The study provides the first prospective evidence of TAVR outcomes in rheumatic aortic regurgitation compared to non-rheumatic cases.

## Key findings

- Rheumatic AR patients had lower rates of ≥mild paravalvular leak compared to non-rheumatic AR patients.
- Three-year all-cause mortality was similar between rheumatic and non-rheumatic AR patients after TAVR.
- Higher STS score, frailty, and aortic angulation were associated with increased mortality in both groups.

## Abstract

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.

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.

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.

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.