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

Background: 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. Methods: 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. Results: 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%, Conclusion: 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.