First Report of Anchoring Via Trans-Leaflet Apposition Stent (ATLAS)

BACKGROUND: Patients with aortic regurgitation (AR) commonly lack calcification, which is critical for anchoring most contemporary transcatheter valves. CASE SUMMARY: A patient with a previous surgically repaired aortic dissection presented with symptomatic severe AR of a native noncalcified valve. The patient was referred for Sapien 3 implantation, selected for its short frame to minimize interaction with a dissection flap. The noncoronary aortic cusp was traversed, and later a stent was positioned across the leaflet. Immediately after intraleaflet stent deployment, the transcatheter valve was inflated, crushing the stent and allowing for anchoring the implanted valve to the outflow tract and the leaflet. The patient had no adverse events and an uneventful recovery. DISCUSSION: Until devices designed specifically for noncalcified AR are broadly available, novel techniques may serve as valuable solutions in carefully selected patients. NOVELTY: This report describes, to our knowledge, the first-in-human application of the anchoring via the trans-leaflet apposition stent (ATLAS) strategy.