What is the clinical evidence from this study?

Study design: Review. Population: Pure Aortic Regurgitation. Intervention: Transcatheter Aortic Valve Implantation (TAVI).

What question did this study set out to answer?

Examine the clinical implications of aortic regurgitation and evaluate evidence for transcatheter strategies.

April 25, 2026Open Access

Transcatheter Aortic Valve Implantation for Pure Aortic Regurgitation

Key Result

Dedicated transcatheter aortic valves for pure aortic regurgitation demonstrate high procedural success and acceptable safety, leading to conditional guideline recommendations for selected patients.

Key Points

Examine the clinical implications of aortic regurgitation and evaluate evidence for transcatheter strategies.
Summarized current guideline recommendations for aortic regurgitation management.
Reviewed the JenaValve Trilogy and J-Valve systems and their efficacy in treating aortic regurgitation.
Analyzed prospective registry data, including the ALIGN-AR trial outcomes.
The JenaValve Trilogy and J-Valve systems show high procedural success and low residual regurgitation.
Guidelines now include a recommendation for TAVI in severe aortic regurgitation patients at high surgical risk.
Registry data indicate improved patient functional status and ventricular remodelling post-TAVI.

Structured PICO

Population

Patients with pure native severe aortic regurgitation (AR)

Intervention

Transcatheter aortic valve implantation (TAVI) using dedicated systems designed for AR (e.g., JenaValve Trilogy and J-Valve)

Dedicated TAVI systems for pure aortic regurgitation overcome anatomical challenges, demonstrating efficacy and safety that have informed new conditional guideline recommendations for high-risk patients.

Abstract

Transcatheter aortic valve implantation (TAVI) has transformed the management of severe aortic stenosis (AS), evolving from a therapy reserved for inoperable patients to a viable treatment across the spectrum of surgical risk. This success has stimulated innovation in transcatheter therapies for other valvular heart diseases, including aortic regurgitation (AR). In contrast to AS, AR is characterised by heterogeneous aetiologies, absence of annular calcification, larger and more elliptical annular dimensions, and concomitant aortopathy. These challenges have limited the efficacy and safety of conventional transcatheter aortic valves (TAVs), use of which in pure native AR is associated with high rates of valve embolisation, significant residual regurgitation, permanent pacemaker implantation, and mortality. The development of dedicated TAVs designed specifically for the treatment of AR has addressed many of these anatomical challenges. The JenaValve Trilogy and J-Valve systems incorporate leaflet-grasping mechanisms that enable secure anchoring independent of calcification, resulting in transformation of procedural and clinical outcomes. Recent prospective registry data, including the landmark ALIGN-AR trial, demonstrate high technical and procedural success rates, low residual regurgitation, acceptable safety profiles, and meaningful improvements in functional status and ventricular remodelling. These data have informed contemporary guideline updates, with the 2025 European Society of Cardiology (ESC)/European Association of Cardiothoracic Surgery (EACTS) Guidelines for the management of valvular heart disease issuing the first conditional recommendation for TAVI in selected patients with severe AR and the National Institute for Health and Care Excellence (NICE) recommending TAVI for native AR in patients for whom surgical AVR is not available or is high risk. This review summarises the clinical implications of AR, examines current guideline recommendations for management, and critically appraises the evidence supporting transcatheter treatment strategies.