Aortic Regurgitation as the Next Frontier in the TAVR Space

Aortic regurgitation (AR) has long been an underdiagnosed and underestimated valvular heart disease. Nevertheless, large cohort studies demonstrated that the prevalence of clinically relevant AR ranges from 1.6% to 4.5% in individuals aged ≥65 years. Despite a markedly increased mortality risk, AR was often treated conservatively, especially in patients considered unsuitable for surgery. Early attempts to treat AR patients with conventional transcatheter devices led to unsatisfactory results, mainly due to elevated rates of valve migration or embolization, and relevant paravalvular regurgitation. Recently, dedicated transcatheter heart valves, such as the JenaValve Trilogy System and the J-Valve, have been introduced and indicated high procedural success rates and improved clinical outcomes. However, both interventional and surgical treatment of AR are associated with increased need for pacemaker implantation, follow-up data is scarce, and referring physicians are often unaware of novel dedicated devices. Awareness needs to be spread to provide optimal treatment for AR patients with increased surgical risk.