Transcatheter Aortic Valve Replacement With Self‐Expanding Valves in Severe Pure Native Aortic Regurgitation—Is It Still Anchored Stably in a Significantly Dilated Ascending Aorta Population?

BACKGROUND: The non-coronary sinus pivot implantation (NCPI) technique has notably improved procedural success rate in transcatheter aortic valve replacement (TAVR) for cases of severe pure native aortic regurgitation (PNAR) when utilizing self-expanding transcatheter heart valves (THVs). Nonetheless, the intrinsic anchoring mechanism remains obscure. AIMS: The aim of this study was to assess the feasibility of implementation of the NCPI method using self-expanding THVs for TAVR in severe PNAR and dilated ascending aortas (AAOs), and to elucidate the anchoring mechanism of the NCPI. METHODS: The study consecutively enrolled patients with severe PNAR and significantly dilated AAOs, who underwent TAVR with a NCPI technique. Clinical outcomes and a composite of all-cause mortality at 30 days and 12 months were assessed. Additionally, the post-TAVR cardiac multidetector computed tomographies (MDCTs) were conducted to investigate the anchoring mechanism. RESULTS: A total of 12 patients were enrolled. The median age was 77 years, and the mean Society of Thoracic Surgery (STS) risk score was 10.1%, with a mean aortic annular perimeter of 80.0 mm, a median ascending aortic diameter of 47.9 mm. Device success rates were 100%. In all patients, post-TAVR cardiac MDCT analysis revealed stable anchorage of the THV via the non-coronary side insertion and the left-coronary side compacting contact achieved by the NCPI method despite the presence of ascending aortic dilation. CONCLUSIONS: Preliminarily speaking, with the implementation of the NCPI method, the utilization of off-label self-expanding THVs for TAVR in severe PNAR and significantly dilated AAOs is deemed feasible. Stable anchorage of the THV was achieved using the NCPI method.