{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T09:04:19Z","timestamp":1785315859568,"version":"3.55.0"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Background: Aortic insufficiency (AI) during long-term left ventricular assist device (LVAD) support creates a maladaptive recirculatory loop that impairs forward flow, increases left ventricular filling pressures, leading to progressive congestion, and accelerates right ventricular dysfunction. Surgical correction carries high risk, making transcatheter aortic valve implantation (TAVI) an alternative strategy, although outcomes are challenged by complex annular geometry and the absence of calcific anchoring. Methods: We performed a retrospective single-center analysis of consecutive LVAD-supported patients undergoing TAVI for native AI. Annular sizing was area-based with a predefined oversizing strategy of approximately 15\u201330%, adjusted to annular geometry. Balloon-expandable valves were implanted using controlled deployment under rapid pacing and temporary LVAD flow reduction. Outcomes were assessed according to VARC-3 definitions. Results: Fourteen patients underwent TAVI. The cohort demonstrated high anatomical complexity, including annular eccentricity (median 0.21 [IQR 0.19\u20130.23]), horizontal aorta (42.9%), and flared left ventricular outflow tract (LVOT) morphology (50%). Median annular area was 528 mm2 (IQR 487\u2013574), with area-derived diameter 25.9 mm (IQR 24.9\u201327.0). Mean oversizing was 21.9% (median 20.0%; range 15.1\u201330.3%). Technical and VARC-3 device success were achieved in 71.4%. Second valve implantation occurred in 28.6%. Procedural mortality was 0%. In-hospital mortality (21.4%) was related to low cardiac output and multi-organ dysfunction rather than device failure. No survivor had moderate or greater residual AI at discharge. Conclusions: In anatomically complex LVAD patients, an anatomy-driven balloon-expandable TAVI strategy achieved elimination of clinically significant AI with zero procedural mortality. In our interpretation, mortality reflected the advanced stage of heart failure at the time of intervention rather than acute device-related failure.<\/jats:p>","DOI":"10.3390\/jcdd13080355","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:16:52Z","timestamp":1785313012000},"page":"355","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balloon-Expandable Transcatheter Aortic Valve Implantation for LVAD-Associated Native Aortic Insufficiency: A Single-Center Experience"],"prefix":"10.3390","volume":"13","author":[{"given":"Bilge","family":"Duran Karaduman","sequence":"first","affiliation":[{"name":"Department of Cardiology, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Telat","family":"Kele\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem","family":"\u00d6zcan \u00c7elebi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinan Sabit","family":"Kocabeyo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulkadir","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Akdi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00dcmit","family":"Kervan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.jchf.2018.07.012","article-title":"Aortic insufficiency during contemporary left ventricular assist device support: Analysis of the INTERMACS registry","volume":"6","author":"Truby","year":"2018","journal-title":"JACC Heart Fail."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.healun.2010.05.018","article-title":"Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices","volume":"29","author":"Pak","year":"2010","journal-title":"J. Heart Lung Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/j.athoracsur.2019.12.030","article-title":"Aortic insufficiency after left ventricular assist device implantation: Predictors and outcomes","volume":"110","author":"Kagawa","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.healun.2014.11.008","article-title":"Concomitant aortic valve procedures in patients undergoing implantation of continuous-flow left ventricular assist devices: An INTERMACS database analysis","volume":"34","author":"Robertson","year":"2015","journal-title":"J. Heart Lung Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.15420\/cfr.2022.21","article-title":"Transcatheter aortic valve replacement and surgical aortic valve replacement outcomes in left ventricular assist device patients with aortic insufficiency","volume":"8","author":"Rali","year":"2022","journal-title":"Card. Fail. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.healun.2019.03.001","article-title":"Short-term results with transcatheter aortic valve replacement for treatment of left ventricular assist device patients with symptomatic aortic insufficiency","volume":"38","author":"Yehya","year":"2019","journal-title":"J. Heart Lung Transplant."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1016\/j.healun.2018.07.002","article-title":"Aortic regurgitation in patients with a left ventricular assist device: A contemporary review","volume":"37","author":"Bouabdallaoui","year":"2018","journal-title":"J. Heart Lung Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1080\/24748706.2019.1706793","article-title":"Transcatheter aortic valve replacement in left ventricular assist device patients with aortic regurgitation","volume":"4","author":"Belkin","year":"2020","journal-title":"Struct. Heart"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1080\/24748706.2018.1540071","article-title":"TAVR in patients with left ventricular assist device: Case report and literature review","volume":"3","author":"Iadanza","year":"2019","journal-title":"Struct. Heart"},{"key":"ref_10","first-page":"100530","article-title":"Transcatheter aortic valve replacement for left ventricular assist device\u2013related aortic regurgitation: The Michigan Medicine experience","volume":"2","author":"Gondi","year":"2023","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"ezae028","DOI":"10.1093\/ejcts\/ezae028","article-title":"Transcatheter management of pure native aortic valve regurgitation in patients with left ventricular assist device","volume":"65","author":"Hinkov","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Dagher, O., Santal\u00f3-Corocoy, M., Perrin, N., Dorval, J.F., Duggal, N., Modine, T., Ducharme, A., Lamarche, Y., Noly, P.-E., and Asgar, A. (2023). Transcatheter valvular therapies in patients with left ventricular assist devices. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1071805"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.healun.2016.05.009","article-title":"Novel echocardiographic parameters of aortic insufficiency in continuous-flow left ventricular assist devices and clinical outcome","volume":"35","author":"Grinstein","year":"2016","journal-title":"J. Heart Lung Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1093\/eurheartj\/ehaa799","article-title":"VARC-3 Writing Committee Valve Academic Research Consortium 3: Updated endpoint definitions for aortic valve clinical research","volume":"42","author":"Piazza","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.cardfail.2023.08.010","article-title":"The hemodynamic effects of aortic regurgitation in patients supported by a HeartMate 3 left ventricular assist device","volume":"30","author":"Rubinstein","year":"2024","journal-title":"J. Card. Fail."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1016\/j.healun.2024.06.018","article-title":"State of the art: Aortic insufficiency in the patient on contemporary durable left ventricular assist device support: Pre- and postoperative assessment and management","volume":"43","author":"Saeed","year":"2024","journal-title":"J. Heart Lung Transplant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1111\/aor.14926","article-title":"Impact of concomitant aortic valve replacement in patients with mild-to-moderate aortic valve regurgitation undergoing left ventricular assist device implantation: EUROMACS analysis","volume":"49","author":"Gliozzi","year":"2024","journal-title":"Artif. Organs."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"101313","DOI":"10.1016\/j.cpcardiol.2022.101313","article-title":"Clinical outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in patients with durable left ventricular assist device","volume":"47","author":"Zaidi","year":"2022","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2752","DOI":"10.1016\/j.jacc.2017.10.006","article-title":"Transcatheter aortic valve replacement in pure native aortic valve regurgitation","volume":"70","author":"Yoon","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/j.jcin.2023.07.026","article-title":"Transcatheter aortic valve replacement for pure native aortic valve regurgitation: The PANTHEON international project","volume":"16","author":"Poletti","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_21","first-page":"101044","article-title":"J-valve transcatheter treatment of native valve aortic regurgitation associated with a left ventricular assist device","volume":"2","author":"Garcia","year":"2023","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_22","first-page":"103662","article-title":"Transcatheter aortic valve replacement for aortic regurgitation in patients with left ventricular assist devices: An institutional experience","volume":"4","author":"Bashir","year":"2025","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s11748-024-02100-3","article-title":"Pooled comparative analysis of transcatheter aortic valve replacement versus surgical aortic valve replacement in patients with left ventricular assist device","volume":"73","author":"Magouliotis","year":"2025","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zhang, X., Liang, C., Zha, L., Zuo, Q., Hu, G., Ding, J., and Tang, S. (2024). Predictors for new-onset conduction block in patients with pure native aortic regurgitation after transcatheter aortic valve replacement with a new-generation self-expanding valve (VitaFlow Liberty): A retrospective cohort study. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-024-03735-z"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/355\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:49:42Z","timestamp":1785314982000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/355"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcdd13080355"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13080355","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}