Self-Expanding Supra-Annular Transcatheter Valve for Pure Native Aortic Insufficiency: Rationale and Technique.

objectiveThe objective was to underscore the feasibility and safety of the Navitor self-expanding transcatheter aortic valve for off-label treatment of pure native aortic insufficiency (AI) in high surgical risk patients and provide a step-by-step procedural guide. KEY STEPS: Steps included: 1) analysis of computed tomography scans for ideal patient selection; 2) deployment of the Navitor transcatheter aortic valve; and 3) assessment of valve function using aortography and echocardiography. POTENTIAL PITFALLS: Device anchoring may be compromised by a lack of calcification, increasing the risk of migration, embolization, and malposition. Oversizing is crucial, but it also increases the risk of conduction disturbances and annular injuries. TAKE-HOME MESSAGES: The Navitor transcatheter aortic valve offers an innovative approach for high-surgical-risk pure native AI. While the procedural success depends on patient selection, careful sizing, and mitigation of anatomic and technical limitations, the Navitor transcatheter aortic valve can be a reasonable bridge therapy until dedicated transcatheter valves for severe AI are commercially approved and widely available.