Novel Technique Employing Transcatheter Balloon-Expandable Valves in Pure Aortic Regurgitation: A Proof-of-Concept Study

Background The aim of this study was to evaluate the hypothesis that employing the "flare the outflow" technique might allow anchoring of transcatheter balloon-expandable valves (BEVs) in patients with pure aortic regurgitation. Methods This was a single-center, 6-patient, consecutive, retrospective observational cohort. Inoperable patients with pure AR were included to perform transcatheter aortic valve implantation. The technique involved deploying BEVs with 2-mm oversizing and "flare the outflow" technique. Computed tomography scans were obtained at baseline and after implantation. Results BEVs with the flared outflow were successfully implanted in all patients. All patients were discharged without device migration and none or trace paravalvular leak. At 1-year follow-up, no deaths, valve dysfunction, or reinterventions were observed. Among the 5 patients out of 6 who underwent follow-up computed tomography scans, findings confirmed the overexpanded outflow of the BEVs compared to the annulus, indicated by mean (24.5 vs. 23.3 mm, p = 0.02) and minimal diameters (24.6 vs. 22.2 mm, p = 0.01). Conclusions The utilization of BEVs incorporating the "flare the outflow" technique demonstrated feasibility and effectiveness in inoperable patients with pure AR. Further studies are required to determine the durability and lifetime management associated with this technique.