Aortic regurgitation: can transcatheter therapies deliver what we need?

Aortic regurgitation (AR) is a common problem, particularly in the elderly, and untreated symptomatic severe AR has a poor prognosis. Based on the ACC/AHA 2020 Guidelines1, surgical aortic valve replacement (SAVR) remains the only recommended treatment for AR, leaving an unmet need for high surgical risk patients. For this reason, out of necessity, clinicians have used off-label commercial transcatheter aortic valve implantation (TAVI) devices, originally developed for the treatment of aortic stenosis (AS), for years in AR patients, but the outcomes are inadequate. However, in Europe, a dedicated TAVI device, JenaValve Trilogy (JenaValve Technology). has obtained European Conformity (CE) mark approval. The recently updated European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) 2025 Guidelines2 have recognised improvements in transcatheter technologies for AR patients with a Class IIb recommendation for TAVI in patients who are ineligible for surgery.

TAVI has become a leading therapy for AS with excellent procedural outcomes. In contrast, when the same commercial TAVI devices have been utilised for patients with AR, the procedural results have been hampered by high rates of valve migration and embolisation,...