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Transcatheter aortic valve replacement (TAVR) can be performed even for pure aortic regurgitation on noncalcified native valves, according to a small case study.

The Sapien 3 balloon-expandable valve was successfully implanted in three such patients deemed inoperable. At 1 month, all three were in New York Heart Association functional classes I or II. Furthermore, transthoracic echocardiography confirmed that no valve was displaced and there was , reported , of Bichat Claude Bernard Hospital in Paris, and colleagues.

"Balloon-expandable valves have been considered not suitable for native aortic regurgitation because of the lack of calcification to anchor the prosthesis. This preliminary experience suggests that TAVR using the Sapien 3 prostheses may be safely performed in selected patients with severe aortic regurgitation on noncalcified native valves and provide hemodynamic and clinical improvement," the group concluded in their letter published online in the Journal of the American College of Cardiology.

"Despite the absence of calcification, native aortic valves with severe aortic regurgitation may offer enough support to allow stable anchoring of balloon-expandable prostheses with no residual aortic regurgitation," they wrote.

Procedures were performed via the transfemoral route; operators opted for conscious sedation and local anesthesia in all three cases. Notably, prostheses were implanted in a position that was more ventricular than normal -- 5 mm below the aortic annulus.

"Of note, the prosthesis and annulus oversizing ratio was >15% and prostheses were overexpanded using some additional contrast volume inflation," according to the authors.

Himbert's group is currently conducting a feasibility study for TAVR in noncalcified native valves.

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