Rescue Transcatheter Aortic Valve Implantation for Severe Native Aortic Regurgitation in a Young Patient with Hypertrophic Obstructive Cardiomyopathy and Cardiogenic Shock: Review of the Literature and Case Presentation

Transcatheter aortic valve implantation (TAVI) for pure native aortic regurgitation (AR) remains technically challenging, primarily because absent annular calcification limits prosthesis anchoring. We reviewed contemporary evidence on TAVI for native AR, focusing on devices, procedural performance, complications, and outcomes. A comprehensive PubMed search identified 371 articles, of which 28 studies comprising 3282 patients met the inclusion criteria; notably, 64.3% were published from 2023 onward, reflecting the rapidly expanding evidence in this field. Conventional off-label devices were evaluated in 60.7% of studies and dedicated AR devices in 35.7%, while 3.6% directly compared both strategies. Technical/device success ranged from 72% to 100%, generally exceeding 85–90% in contemporary series, while 30-day mortality ranged from 0% to 23%. To illustrate the technical challenges and expand this evidence, we present a 24-year-old man with MYH7-associated hypertrophic obstructive cardiomyopathy and severe post-myectomy AR complicated by biventricular failure, cardiogenic shock, and multiorgan dysfunction. Given prohibitive surgical risk, rescue transfemoral TAVI was performed. Despite embolization of the first balloon-expandable prosthesis, a second valve was successfully implanted using an individualized anchoring strategy. At 1 year, the patient was in NYHA class I with biventricular recovery. TAVI represents an evolving alternative for carefully selected patients with severe native AR and prohibitive surgical risk.