title: Transapical transcatheter aortic valve for severe aortic regurgitation: expanding the limits.
abstract: OBJECTIVE
  This study sought to evaluate the self-expandable ACURATE TA device (Symetis SA, Ecublens, Switzerland) in a cohort of patients with pure aortic regurgitation (AR).
  
  
  BACKGROUND
  Transcatheter aortic valve replacement (TAVR) has been initially considered as an alternative for high-risk patients with aortic stenosis. Although the current experience is limited, TAVR might be also an alternative to treat patients with pure, severe AR.
  
  
  METHODS
  Between April 2012 and December 2013, a total of 8 high-risk patients with pure, severe AR were enrolled (grade III+). Clinical and hemodynamic data as well as data on device and procedure parameters and outcomes were collected.
  
  
  RESULTS
  Patient mean was 72.5 ± 8.4 years, and 37.5% of patients were female. Logistic EuroSCORE was 34.0 ± 7.9% and the Society of Thoracic Surgeons score was 7.3 ± 3.3% on average. Two patients had undergone emergency aortic operation before due to acute type A aortic dissection, and both were treated by replacement of the ascending aorta (including root reconstruction) and the aortic arch combined with or without E-vita Open stent graft (Jotec GmbH, Hechingen, Germany) (January 2011 and March 2012), whereas the other patients experienced primary AR. All patients underwent successful transapical TAVR with the transapical ACURATE TA device (size small, n = 1, size medium, n = 3, size large, n = 4) without any intraprocedural complications according to the Valve Academic Research Consortium 2 criteria. Post-procedure AR grade I+ or lower, as revealed by transoesophageal echocardiography and angiography, was present in all 8 patients. At 30 days, the stroke incidence and all-cause mortality rate were 0%.
  
  
  CONCLUSIONS
  This small single-center series demonstrates the feasibility of transapical TAVR with the self-expandable ACURATE TA device in high-risk patients with severe AR.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany. Electronic address: daniel.wendt@uk-essen.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.affiliation: Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Pasa
authors.affiliation: Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Karim
authors.initials: K
authors.lastname: El-Chilali
authors.affiliation: Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Fadi
authors.initials: F
authors.lastname: Al-Rashid
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany.
authors.forename: Daniel Sebastian
authors.initials: DS
authors.lastname: Dohle
authors.affiliation: Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017023:Coronary Angiography; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic regurgitation; aortic valve; high-risk; transcatheter aortic valve replacement