First-in-human TAVR With Navitor Self-expanding Intra-annular Valve in LVAD–Associated Aortic Regurgitation

Background: Aortic regurgitation (AR) is commonly reported in patients with left ventricular assist device (LVAD) and is associated with poor outcomes. Surgical management of AR in these patients carries high operative mortality. Dedicated transcatheter options for AR are limited to research trials and are not commercially available. Transcatheter aortic valve replacement (TAVR) in patients with LVAD and AR is challenging due to a lack of adequate annular calcium to anchor the valve with a high risk of embolization. Methods: Two patients with severe LVAD-associated AR and heart failure were referred for consideration for TAVR. Evaluation of the aortic valve revealed no significant valve calcification. They were attempted to be enrolled in trials of the JenaValve and J-valve but failed screening due to the presence of LVAD. Compassionate use of these AR-dedicated TAVR valves was closed due to registries that are going to begin later in 2025. Hence, after heart team approach, we proceeded with commercially available Navitor self-expanding intra-annular valve (Abbott) that has the largest aortic diameter. Results: We were able to successfully treat AR due to LVAD using the Navitor valve without valve migration at the recommended depth. Conclusions: Commercial TAVR devices for LVAD-associated AR carry high risk of embolization in the absence of valve calcification. Abbott Navitor valve with its unique frame design can be used safely to treat AR associated with LVAD.