Compassionate use of the Trilogy Valve in an LVAD patient with severe aortic insufficiency led to marked functional recovery, achieving independent ambulation and 1,145 feet on the 6-minute walk test.
Case Report (n=1)
Does compassionate use of the Trilogy Valve improve functional recovery in a patient with an LVAD and severe aortic insufficiency?
Compassionate use of the Trilogy transcatheter valve for severe aortic insufficiency in a patient with an LVAD resulted in marked functional recovery and independent ambulation.
Aortic insufficiency (AI) develops in approximately one-third of patients 3 years after continuous-flow left ventricular assist device (LVAD) implantation. Transcatheter aortic valve replacement (TAVR) has recently emerged as a potential option. However, the use of TAVR in patients with LVADs is limited. There are currently only two transcatheter valves, J-Valve and Trilogy Valve, available under expanded access for aortic regurgitation, particularly for patients with LVAD. This case describes a 47 year old male with destination HeartMate 3 LVAD complicated by methicillin–susceptible Staphylococcus aureus bacteremia and severe AI causing cardiogenic shock. Despite inotropic and pharmacologic support, his course was marked by profound deconditioning and fluctuating renal and hepatic function. After a multidisciplinary review, the patient underwent compassionate use of the Trilogy Valve. Post-procedure, he demonstrated marked functional recovery, improving from maximal assistance to independent ambulation, reaching 1,145 feet during 6 minute walk test, and achieving an Activity Measure Post-Acute Care Basic Mobility score of 24/24. The Trilogy Valve is currently under investigation in the ALIGN-AR studies, but has only been used in LVAD patients under compassionate use in the United States. Ongoing registry data (JENA-VAD) and future research are needed to validate procedural standardization, hemodynamic effects, and rehabilitation potential and outcomes in this high-risk population.
Eid et al. (Tue,) conducted a case report in Severe aortic insufficiency and cardiogenic shock in a patient with a left ventricular assist device (n=1). JenaValve Trilogy Heart Valve System was evaluated on Functional recovery (ambulation, 6-minute walk test, Activity Measure Post-Acute Care Basic Mobility score). Compassionate use of the Trilogy Valve in an LVAD patient with severe aortic insufficiency led to marked functional recovery, achieving independent ambulation and 1,145 feet on the 6-minute walk test.