Noncoronary Sinus Pivot Implantation (NCPI) Strategy for Transcatheter Aortic Valve Replacement With Self-Expanding Valve in Pure Native Aortic Regurgitation: A Multicenter, Registry Study From the CCA Database-NTCVR.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) for pure native aortic regurgitation (PNAR) remains challenging. While the noncoronary sinus pivot implantation (NCPI) strategy showed promise with VitaFlow valve, its efficacy with other valves needs validation.

Aims: This study aims to evaluate the real-world efficacy of the TaurusElite valve in patients with PNAR and to assess the impact of the NCPI strategy on procedural outcomes.

Methods: This registry-based analysis included 121 PNAR patients from the prospective CCA Database-NTCVR who underwent transfemoral TAVR with TaurusElite valve at seven Chinese centers (April 2022 to October 2024). A core laboratory assessed procedural imaging to classify patients into NCPI (n = 81) and non-NCPI (n = 37) groups. Outcomes were evaluated per VARC-3 criteria.

Results: The TaurusElite valve demonstrated good effectiveness (overall device success 90.9%). NCPI strategy showed superior outcomes: higher success rate (98.8% vs. 81.1%, p < 0.001), no valve-in-valve implantation (0% vs. 16.2%, p < 0.001), and lower permanent pacemaker requirement (3.7% vs. 18.9%, p = 0.006). NCPI (OR:6.08, 95% CI: 3.27-28.68) independently predicted success.

Conclusions: The TaurusElite valve is an effective treatment for PNAR, and the NCPI strategy provides significant additional benefits in improving procedural success and reducing complications compared to conventional approaches.