Stable Valve Function After Post-Transapical TAVR With Anchoring Strut Fracture: A 3-Year Multimodal Imaging Follow-up Case Report

Abstract Background Transcatheter aortic valve replacement (TAVR) for native aortic regurgitation (AR) remains technically challenging due to the absence of annular calcification and difficulties in achieving stable anchoring. Mechanical complications such as anchoring strut fracture are rare but may have implications for long-term valve durability. Case summary A 64-year-old man with severe symptomatic native AR underwent transapical TAVR using a 29-mm self-expanding J-Valve system. Routine echocardiography and gated CT on postoperative day 7 identified an isolated fracture of the right coronary sinus anchoring strut without migration, leaflet dysfunction, or hemodynamic compromise. No balloon post-dilatation was performed. Serial multimodal imaging over nearly three years demonstrated persistent structural stability, preserved valve function, and marked left-ventricular reverse remodeling. Discussion This case provides long-term multimodal imaging follow-up of isolated anchoring strut fracture after TAVR for native AR. Early fracture detection and absence of calcification support a deployment-related stress mechanism rather than late cyclic fatigue. Although this favorable evolution suggests that isolated fracture does not necessarily result in immediate structural valve dysfunction, prognostic conclusions cannot be generalized. Careful, individualized imaging surveillance remains essential.