Clinical Conversation in Interventional Cardiology: First-in-Human TAVR With Navitor Self-Expanding Intra-Annular Valve in LVAD–Associated Aortic Regurgitation-Clinical Conversation in Interventional Cardiology: First-in-Human TAVR With Navitor Self-Expanding Intra-Annular Valve in LVAD

Clinical Conversation in Interventional Cardiology: First-in-Human TAVR With Navitor Self-Expanding Intra-Annular Valve in LVAD–Associated Aortic Regurgitation

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Video Transcription

Video Summary

The panel discusses off-label TAVR to treat LVAD-associated “disuse” aortic regurgitation (AR), a common complication that becomes moderate–severe in up to 20–30% by 1 year and ~50% by 3 years. Because dedicated AR devices are not yet widely available in the US and often exclude LVAD patients, the team reports two first-in-human cases using the Abbott Navitor self-expanding valve. They emphasize challenges of non-calcified native AR and LVAD suction increasing embolization risk, recommending >20% oversizing, general anesthesia with TEE guidance, and preparedness for bailout. Navitor’s larger outflow diameter was chosen to improve aortic anchoring and prevent migration; both cases had successful deployment with elimination of AR. One patient developed early leaflet thrombosis attributed to aortic-root flow stasis and delayed therapeutic anticoagulation, highlighting the need for rapid INR optimization and possible LVAD speed considerations. Ongoing trials of dedicated AR valves (e.g., J-Valve, JenaValve) and LVAD-specific registries are anticipated.

Asset Caption

closed captions are computer-generated

Keywords

off-label TAVR

LVAD-associated aortic regurgitation

disuse aortic regurgitation

Abbott Navitor self-expanding valve

valve oversizing and embolization risk

leaflet thrombosis and anticoagulation management