Transcatheter Options for Severe Aortic Regurgitation Without Significant Calcification

Guideline Position

The American College of Cardiology, American Association for Thoracic Surgery, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons expert consensus categorically excludes severe aortic regurgitation from TAVR indications due to insufficient evidence to establish a favorable risk-benefit ratio, regardless of surgical risk 1, 2
TAVR devices were designed and validated exclusively for calcified, stenotic aortic valves, where calcification provides structural anchoring support 2
Severe aortic regurgitation presents fundamentally different anatomic challenges, including lack of calcification for anchoring, dilated annulus, and requirement for complete seal rather than gradient reduction 2
The exclusion of TAVR for severe aortic regurgitation applies to all surgical risk categories, based on the absence of clinical trial data, not proven harm 1, 2

For patients with severe symptomatic aortic regurgitation, surgical aortic valve replacement remains the gold standard for acceptable surgical candidates 2
The American College of Cardiology recommends medical management with afterload reduction for prohibitive surgical risk patients 2
Enrollment in clinical trials investigating aortic regurgitation-specific transcatheter devices may be appropriate for prohibitive-risk patients 2

The American College of Cardiology and other societies recommend that any consideration of transcatheter approaches for severe aortic regurgitation mandates Heart Team evaluation, involving interventional cardiology, cardiac surgery, imaging specialists, and heart failure specialists 2, 3
The Society of Thoracic Surgeons suggests that a multidisciplinary team approach is essential for evaluating patients with severe aortic regurgitation for transcatheter valve replacement 2