Transcatheter aortic valve implantation (TAVI) for pure aortic valve regurgitation (AR) with off-label devices is challenging because of the increased risk for transcatheter heart valve (THV) embolisation or migration and paravalvular leak in the absence of aortic valve calcification1. The Trilogy transfemoral TAVI system (JenaValve) recently received a CE (European Conformity) mark for the treatment of aortic regurgitation and aortic stenosis. It features unique locators that align the THV with the native cusps of the valve and enables anchoring in pure AR patients. Early data on the Trilogy valve in AR patients have shown promising results (Tamm AR, et al. JenaValve Trilogy for treatment of aortic regurgitation: worldwide first results. EuroPCR 2022. Paris, France).Our patient, a 69-year-old female with worsening symptoms of heart failure (NYHA Class III) was referred to our institution because of severe AR. She had a history of surgical mitral valve repair five years earlier and persistent atrial fibrillation. Echocardiography showed a severely reduced left ventricular ejection fraction, dilation of the left ventricle and severe AR due to a left coronary cusp (LCC) perforation (Figure...
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