{"id":"5cd71b00f0ca","type":"article","url":"https://hartvaat.nl/2026/03/23/transapicale-tavi-met-de-j-valve-bij-ernstige-aortaklepinsufficientie-vergelijkb/","title":"Transapicale TAVI met de J-Valve bij ernstige aortaklepinsufficiëntie: vergelijkbaar met chirurgie","title_en":"Comparing TA-TAVR and SAVR in severe aortic regurgitation: outcomes and valve haemodynamics","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["aortainsufficiëntie","aortastenose","tavi"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003969?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003969?rss=1","authors":["He","Z.","Cai","D.","Li","M.","Feng","Z.","Liang","C.","Ma","R.","Jian","Z.","Xiao","Y."],"significance":6,"published":"2026-03-23","source_date":"2026-03-23","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/tavi-transcatheter-aortaklepimplantatie/","https://hartvaat.nl/kennis/kleplijden/aortastenose/"],"congress":"","summary_en":"Transcatheter aortic valve replacement (TAVR) is already recommended for some high-risk patients with aortic regurgitation (AR), but evidence versus surgical replacement (SAVR) is limited. In this retrospective single-centre study (369 patients with severe AR; 256 transapical TAVR with the J-Valve system, 113 SAVR), 76 matched pairs were compared after propensity score matching. There were no differences in mortality, stroke, heart-failure rehospitalisation, pacemaker implantation or paravalvular leakage at 30 days or 2 years. The TAVR group had superior valve haemodynamics, while reduction in left ventricular dimensions was greater after SAVR; ejection-fraction improvement was comparable. Transapical TAVR with the J-Valve is thus an effective treatment for severe AR with outcomes comparable to surgery, especially in high-risk patients.","created":"2026-07-03T10:32:22Z","updated":"2026-07-03T13:31:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Transkatheter-aortaklepimplantatie (TAVI) wordt al aanbevolen bij sommige hoogrisicopatiënten met aortaklepinsufficiëntie (AR), maar het bewijs ten opzichte van chirurgische klepvervanging (SAVR) is beperkt. In deze retrospectieve single-centerstudie (369 patiënten met ernstige AR; 256 transapicale TAVI met het J-Valve-systeem, 113 SAVR) werden na propensity score-matching 76 paren vergeleken. Er waren geen verschillen in sterfte, beroerte, hartfalenheropname, pacemakerimplantatie of paravalvulaire lekkage na 30 dagen of 2 jaar. De TAVI-groep had superieure klep-hemodynamiek, terwijl de afname van de linkerventrikeldimensies groter was na SAVR; de verbetering van de ejectiefractie was vergelijkbaar. Transapicale TAVI met de J-Valve is dus een effectieve behandeling voor ernstige AR met uitkomsten vergelijkbaar met chirurgie, vooral bij hoogrisicopatiënten.","abstract_original":"<sec><st>Background</st>\n<p>Transcatheter aortic valve replacement (TAVR) has already been recommended for some high-risk patients with aortic valve regurgitation, but there is still a lack of evidence regarding its early-term and medium-term safety and effectiveness compared with surgical aortic valve replacement (SAVR).</p>\n</sec>\n<sec><st>Methods</st>\n<p>This retrospective study included patients who underwent bioprosthetic aortic valve replacement for severe aortic regurgitation (AR) at a single centre between January 2018 and December 2023. All patients in the TAVR group received the J-Valve system via transapical (TA) approach. Propensity score matching (PSM) was used to balance the groups. The primary endpoint was 2-year all-cause mortality. Secondary endpoints included other clinical events, left ventricular (LV) function recovery and prosthesis haemodynamics, assessed by transthoracic echocardiography.</p>\n</sec>\n<sec><st>Results</st>\n<p>A total of 369 patients (median age 68 years, 26.6% female) were enrolled. Of these, 256 underwent TA-TAVR and 113 underwent SAVR. After 1:1 PSM, 76 matched pairs were included. There were no statistical differences between the groups in all-cause mortality, cardiovascular mortality, stroke, heart failure rehospitalisation, permanent pacemaker implantation or moderate to severe paravalvular leakage at 30 days or 2 years. Before PSM, left ventricular ejection fraction (LVEF) improved in the TAVR group (57% (IQR: 45&ndash;63%) vs 61% (IQR: 55&ndash;65%), p&lt;0.001), with no significant change in the SAVR group (61% (IQR: 55&ndash;65%) vs 62% (IQR: 59&ndash;66%), p&gt;0.05). After PSM, LVEF improvement was comparable between groups (+4.0% (IQR: &ndash;1.5 to 10.0) vs +2.0% (IQR: &ndash;3.0 to 9.5), p=0.430). Haemodynamics was superior in the TAVR group (p&lt;0.001), while regression of LV dimensions was greater in the SAVR group.</p>\n</sec>\n<sec><st>Conclusion</st>\n<p>In patients with severe AR, using the J-Valve for TA-TAVR showed comparable outcomes to SAVR regarding mortality and other clinical events. TAVR provided superior valve haemodynamics and was an effective treatment that significantly improved LV function, especially in high-risk patients.</p>\n</sec>"}