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76-year-old man with severe degenerative aortic stenosis, coronary artery disease, and progressive congestive heart failure with severe systolic dysfunction underwent implantation of a Heartmate II left ventricular assist device (LVAD; Thoratec Corporation, Pleasanton, CA) after developing refractory cardiogenic shock. Because there was moderate aortic insufficiency (AI), the aortic valve was closed with a pledgeted central coaptation stitch that approximated the Noduli of Arantius with minimal residual regurgitation.

Percutaneous Intervention for Recurrent Aortic Insufficiency in a Patient With a Left Ventricular Assist Device and a Centrally Oversewn Aortic Valve