Adaptive Sealing in Protruding LVOT Calcification During TAVR: A 4-Patient Case Series.

BACKGROUND

Protruding left ventricular outflow tract calcification represents a high-risk anatomical feature for transcatheter aortic valve replacement, predisposing to paravalvular regurgitation (PVR), annular injury, and conduction disturbance.

CASE SUMMARY: We present 4 patients with severe symptomatic aortic stenosis and protruding left ventricular outflow tract calcific nodules treated with the Navitor self-expanding valve system. Despite uniformly hostile landing-zone anatomy, procedural success was achieved in all cases. Residual PVR ranged from trivial to mild-to-moderate, with no patient developing moderate-or-greater PVR. All patients demonstrated hemodynamic improvement and early symptomatic benefit.

CONCLUSIONS

Calcific morphology and nodule orientation, rather than calcium burden alone, may be key determinants of PVR following Navitor implantation in hostile landing-zone anatomy. These findings are hypothesis-generating; the observed pattern of adaptive cuff sealing requires verification in larger, preferably comparative studies before conclusions regarding device-specific sealing mechanisms can be drawn.