Effectiveness of Transcatheter Aortic Valve Replacement in Pure Severe Native Aortic Valve Regurgitation: A Systematic Review and Meta-analysis

Transcatheter aortic valve replacement (TAVR) has become a well-established treatment for aortic stenosis, and its use is expanding to other valvular pathologies. Surgical aortic valve replacement remains the standard for patients with severe aortic regurgitation (AR), especially in those without concurrent aortic stenosis. However, in recent years, TAVR has emerged as a potential option for patients with severe native aortic valve regurgitation (NAVR), despite challenges such as the absence of calcification needed for valve anchoring. We conducted a systematic review and meta-analysis to evaluate the clinical outcomes of TAVR in NAVR. Databases including PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov were searched through June 10, 2024. A total of 23 studies comprising 4397 patients were included. All-cause mortality at 30 days post-TAVR was 12%, while device success was achieved in 86% of cases. Rates of myocardial infarction, stroke, and major bleeding were low at 3%, 3%, and 8%, respectively. Acute kidney injury ≥ stage 2 occurred in 8% of patients, and 6% experienced major vascular complications. Permanent pacemaker implantation was required in 15% of cases. Moderate-to-severe paravalvular leak and postprocedural moderate-to-severe AR were reported in 10% and 9% of patients, respectively, with wide confidence intervals reflecting variability in outcomes. Overall, these findings suggest that TAVR is a reasonable alternative for selected patients with NAVR, in carefully selected high-risk patients with AR, especially those deemed high risk for surgery or when surgery is contraindicated. However, further large-scale studies with extended follow-up are needed to better define patient selection criteria and to validate the long-term efficacy and safety of TAVR in this population.