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.