NCPI-Plus: A Novel TAVR Anchoring Strategy for PAR With Enlarged LVOT.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) for pure aortic regurgitation (PAR) with an enlarged left ventricular outflow tract (LVOT) remains challenging due to inadequate anchoring. CASE SUMMARY: A 74-year-old woman with severe PAR and an enlarged LVOT (perimeter 93.7 mm), deemed high risk for surgery, underwent TAVR using a 30-mm self-expanding valve. A modified noncoronary sinus pivot implantation (NCPI-plus) technique was performed, deploying the valve above the virtual annular plane on the noncoronary sinus side to create a supra-annular pivot point. Postprocedural imaging and 12-month follow-up confirmed stable anchoring and excellent valve function without regurgitation. DISCUSSION: The NCPI-plus technique provides stable anchoring for TAVR in PAR patients with dilated LVOT, by using the supra-annular pivot point on the noncoronary sinus side as its core design to prevent downward valve displacement during deployment. TAKE-HOME MESSAGE: The NCPI-plus technique offers a feasible anchoring strategy for TAVR in PAR patients with enlarged LVOT.