Transcatheter Management of Severe Aortic Insufficiency in a Left Ventricular Assist Device Recipient with a Small Aortic Annulus

We report the case of a 72-year-old woman with a HeartMate III left ventricular assist device who developed severe aortic regurgitation and New York Heart Association Class III symptoms. Given her high surgical risk and the presence of a small aortic annulus (mean diameter 18.4 mm), transfemoral transcatheter aortic valve replacement was performed using a 26-mm Evolut PRO+ self-expanding valve under transesophageal echocardiographic guidance. Temporary reduction of left ventricular assist device (LVAD) speed prevented ventricular migration during deployment. The procedure resulted in complete resolution of regurgitation without complications. This case demonstrates the feasibility and safety of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic regurgitation in patients with LVADs and small annuli, when meticulous pre-procedural planning and careful intraoperative management are employed.

Keywords: Advanced heart failure, aortic regurgitation, left ventricular assist device, transcatheter aortic valve replacement