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Updated: Aug 8, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
NCPI-Plus: A Novel TAVR Anchoring Strategy for PAR With Enlarged LVOT
Weijing Zhang1, Jinxue Liu2, Dawei Lin1
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Key Laboratory of Viral Heart Diseases, Shanghai, China.
Background:
Transcatheter aortic valve replacement (TAVR) for pure aortic regurgitation (PAR) with an enlarged left ventricular outflow tract (LVOT) remains challenging due to inadequate anchoring.
Case Summary:
A 74-year-old woman with severe PAR and an enlarged LVOT (perimeter 93.7 mm), deemed high risk for surgery, underwent TAVR using a 30-mm self-expanding valve. A modified noncoronary sinus pivot implantation (NCPI-plus) technique was performed, deploying the valve above the virtual annular plane on the noncoronary sinus side to create a supra-annular pivot point. Postprocedural imaging and 12-month follow-up confirmed stable anchoring and excellent valve function without regurgitation.
Discussion:
The NCPI-plus technique provides stable anchoring for TAVR in PAR patients with dilated LVOT, by using the supra-annular pivot point on the noncoronary sinus side as its core design to prevent downward valve displacement during deployment.
Take-Home Message:
The NCPI-plus technique offers a feasible anchoring strategy for TAVR in PAR patients with enlarged LVOT.
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