Transcatheter aortic valve implantation for severe aortic regurgitation with Trilogy system: Initial Southeast Asia experience

Aortic regurgitation (AR) is a common valvular heart disease, with a cohort study reporting an approximate prevalence of 13% in men and 8.5% in women.1 Severe AR portends significant mortality and morbidity if untreated.2 Aortic valve surgery remains the gold standard for management.3 However, a significant proportion are treated conservatively because of high surgical risks, significant comorbidities, or the patient’s refusal of surgery.4 Despite the success of transcatheter aortic valve implantation (TAVI) for the management of aortic stenosis (AS), existing devices have not been designed for the treatment of AR. In patients with limited surgical options, these devices have been used off-label with higher associated risks.5 The recent development of dedicated devices has changed the landscape.6,7 In particular, the ALIGN-AR study demonstrated the safety and efficacy of the use of the Trilogy transcatheter heart valve (THV) (JenaValve Technology, Irvine, CA, US) in treating patients with severe tricuspid AR.7 The Trilogy valve is a porcine pericardial THV composed of 3 leaflets within a self-expanding nitinol stent scaffold. It has 3 locators which are centred on the native aortic cusps, limiting implant depth and allowing clipping to the native leaflets for secure anchoring.7 To the authors’ knowledge, this is the first case series in Southeast Asia (SEA) to describe the initial experience with the Trilogy THV for the treatment of severe tricuspid AR.