The patient was diagnosed with Pure Native Aortic Regurgitation (PNAR), a condition in which the aortic valve fails to close properly, allowing blood to flow backwards into the heart. In this case, the severe leakage was caused by a perforation in one of the native aortic valve leaflets. His medical history of mitral valve replacement further increased the complexity of treatment.
The aortic valve regulates the flow of blood from the heart into the aorta, the main artery responsible for supplying blood to the body. When the valve does not close completely, blood flows backwards into the heart, resulting in aortic regurgitation. The severity of the leakage and the presence of a leaflet perforation made the patient's condition particularly challenging to manage.
Treating pure native aortic regurgitation through a catheter-based procedure presents specific technical challenges. Unlike aortic stenosis, where calcium deposits can help secure an implanted replacement valve, patients with pure native aortic regurgitation often have little or no calcification to support the device. This makes achieving stable positioning and secure anchoring of the replacement valve more difficult. The patient's previous mitral valve replacement introduced an additional consideration during treatment planning.
The HANCHOR valve is specifically designed to address the anchoring challenges associated with pure native aortic regurgitation. It combines a balloon-expandable frame with a dedicated anchoring element made of nitinol, a flexible metal alloy. The anchoring mechanism is designed to engage the native valve leaflets and help stabilise the replacement valve, including in cases where the surrounding anatomy provides limited support.
During the TAVR procedure, the medical team delivered the replacement valve through a catheter and positioned it within the patient's existing aortic valve. The minimally invasive technique enabled the doctors to replace the faulty valve without resorting to conventional open-heart valve replacement surgery.
The post-procedure assessment reported no residual aortic regurgitation, no valve stenosis or abnormal narrowing, and no paravalvular leak, which refers to leakage around the implanted valve. No significant abnormality in the heart's electrical conduction was reported. The patient was discharged from the hospital after three days.
Dr. Rajaram Ananantharaman, Senior Consultant Interventional Cardiologist, Kauvery Hospital, Alwarpet, Chennai, said, “Pure native aortic regurgitation can be challenging to treat using a catheter-based approach because the limited calcium deposits in the native valve can make it difficult to secure a replacement valve. Also, the perforation of the aortic valve leaflet, combined with the patient’s history of mitral valve replacement, added further complexity to treatment planning. The HANCHOR valve’s dedicated anchoring mechanism helped us address the challenges of valve positioning. The immediate post-procedure findings were encouraging, with no residual aortic regurgitation or leakage around the implanted valve reported. This procedure demonstrates the importance of individualised treatment planning and specialised valve technology in managing complex structural heart conditions.”
Commenting on the treatment, Dr. Aravindan Selvaraj, Co-founder and Executive Director, Kauvery Group of Hospitals, said, “At Kauvery, we are committed to advancing patient care through clinical expertise, innovation and the adoption of appropriate medical technologies. Success stories such as this highlight the importance of combining specialised treatment approaches with careful clinical assessment to address complex cardiac conditions. We continue to focus on bringing advanced treatment options to patients while maintaining the highest standards of patient safety and care.”
The procedure highlights the use of specialised valve technology to address complex cases of pure native aortic regurgitation, particularly when anatomical challenges and a history of previous heart valve surgery complicate conventional treatment approaches.
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