TAVR for Severe Non-calcified Aortic Regurgitation Combined With Aortic Stenosis Complicated by High-Grade Atrioventricular Block: A Case Report

Background Aortic regurgitation is a common valvular heart disease in the elderly population. While transcatheter aortic valve implantation has become an established treatment for patients with calcified aortic stenosis, its application in cases dominated by aortic regurgitation and lacking valvular calcification remains technically challenging. Careful procedural planning is essential in such anatomically complex scenarios. Case Presentation We report the case of a 71-year-old male who presented with chest pain and syncope. Transthoracic echocardiography revealed severe aortic regurgitation combined with moderate aortic stenosis. Computed tomography showed a tricuspid aortic valve without calcification and a tubular left ventricular outflow tract. After thorough evaluation, an elective TAVR was performed using a 23 mm self-expanding prosthesis. Due to the absence of calcification and the high volume of regurgitation, high implantation and rapid pacing were employed to reduce the risk of valve migration. The valve was deployed using a slow-to-fast release technique, with real-time adjustments based on position and stability. Postoperative imaging confirmed successful implantation without paravalvular leakage. However, the patient developed high-grade atrioventricular block, which persisted for four days, requiring permanent pacemaker implantation. He was discharged one week after the procedure in stable condition. Conclusions This case demonstrates the feasibility of TAVR in a patient with predominant aortic regurgitation with moderate aortic stenosis and no calcification. Success in such complex anatomical settings depends on individualized procedural strategies. The "SPEED" approach—Strategy of pacing, high initial positioning, Employ guidewire, Extended observation, and Deployment—may improve safety and outcomes in carefully selected patients.