Why the study?
TAVR for pure aortic regurgitation remains technically challenging due to the lack of calcified annular structures for device anchoring.
Does TAVR using a self-expanding valve with the NCPI technique improve hemodynamics and symptoms in a patient with severe pure aortic regurgitation and sinus of Valsalva aneurysm?
Does TAVR using a self-expanding valve with the NCPI technique improve hemodynamics and symptoms in a patient with severe pure aortic regurgitation and sinus of Valsalva aneurysm?
Self-expanding TAVR using anatomy-tailored anchoring (NCPI) is a viable strategy for pure aortic regurgitation with complex root anatomy, achieving stable deployment and functional recovery.
Answers are grounded in this paper and cite their sources.
Should not yet change practice in pure AR; leaves open feasibility of NCPI-anchored self-expanding TAVR in complex root anatomy.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) for pure aortic regurgitation (PAR) remains technically challenging because of the lack of calcified annular structures for device anchoring. CASE SUMMARY: We report successful noncoronary sinus pivot implantation (NCPI) of a 29-mm self-expanding valve in a high-risk PAR patient (Society of Thoracic Surgeons 8.2%) with extreme root dilatation and no calcification under the STABLE protocol. Post-procedure imaging confirmed hemodynamic success, no paravalvular leak, ventricular recovery, and optimal root remodeling. DISCUSSION: This case highlights the role of annular-subannular anchoring (NCPI technique) and multimodality imaging in TAVR PAR with sinus of Valsalva aneurysm, addressing migration risks and expanding procedural feasibility beyond calcific stenosis-a critical advancement in an understudied population. TAKE-HOME MESSAGE: Self-expanding TAVR using anatomy-tailored anchoring (eg, NCPI) is viable in PAR with complex root anatomy, requiring imaging-guided precision for stable deployment and functional recovery.
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Chen et al. (2025) studied this question.
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