Transcatheter Aortic Valve Replacement (TAVR) with JenaValve Trilogy System for Aortic Regurgitation Following a David Procedure: A Case Report

Background Valve-sparing aortic root replacement (VSARR), also known as the David procedure, is a preferred surgical option for patients with aortic root aneurysms, offering preservation of the native valve and avoidance of lifelong anticoagulation. However, long-term durability remains a concern, with progressive aortic regurgitation (AR) occurring in up to 20% of cases. Redo surgical valve replacement is standard for failed VSARR, but transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative for high-risk patients, despite technical challenges in non-calcified anatomy. This case highlights the first reported use of the JenaValve Trilogy system to treat post-David procedure AR. Case summary A 71-year-old female developed severe AR ten years after undergoing a David procedure for sinus of Valsalva aneurysm. Echocardiography showed eccentric AR due to left and non-coronary cusp malcoaptation, with an effective regurgitant orifice of 0.28 cm². Due to comorbidities and patient preference, TAVR was selected over surgical redo. A 23 mm Trilogy JenaValve was implanted via transfemoral access under conscious sedation. Post-procedural aortogram confirmed successful deployment and absence of residual regurgitation. The patient recovered uneventfully and was discharged on postoperative day five. Discussion This case demonstrates the feasibility and safety of the Trilogy JenaValve in managing post-VSARR AR, even in the absence of annular calcification. Its leaflet-clipping design offers secure anchoring in complex anatomies. While promising, further clinical experience and long-term data are needed to define the role of this system in failed valve-sparing repairs.