Aortic Ring Annuloplasty During Left Ventricular Assist Device Implantation for Severe Aortic Regurgitation: A Case Report

Aortic regurgitation (AR) is a well-recognized challenge in patients undergoing left ventricular assist device (LVAD) implantation, as it promotes closed-loop circulation, limits effective unloading, and compromises device performance. Conventional surgical strategies, including valve replacement or central coaptation stitches, have limitations. We report the case of a 59 year old man with nonischemic cardiomyopathy who was admitted with worsening heart failure and echocardiographic evidence of severe AR due to central malcoaptation of a structurally normal trileaflet aortic valve, along with severe tricuspid regurgitation. The patient underwent concomitant internal aortic ring annuloplasty, tricuspid valve repair with De Vega annuloplasty, and HeartMate 3 LVAD implantation. Postoperative transesophageal echocardiography showed only trace AR and mild tricuspid regurgitation. Recovery was uneventful, and valve function remained stable at 2 month follow-up. This case highlights the feasibility of internal geometric ring annuloplasty as an effective surgical adjunct for managing AR during LVAD implantation. This technique provides annular stabilization, preserves native leaflet function, and minimizes prosthetic burden, making it a physiologic and potentially durable alternative. In the context of mechanical circulatory support, it may fill an important therapeutic gap and deserves further evaluation in future studies.