What is the clinical evidence from this study?

Study design: Case Report. Population: Severe native aortic regurgitation due to cusp perforation after healed infective endocarditis (n=1). Intervention: Transfemoral TAVI using the JenaValve Trilogy system. Primary outcome: Hemodynamic outcome and paravalvular leak.

What question did this study set out to answer?

To address the challenges of transcatheter aortic valve implantation (TAVI) in patients with severe aortic regurgitation resulting from cusp perforation after infective endocarditis.

July 18, 2026JACC Case Reports0 citationsOpen Access

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Transcatheter Aortic Valve Implantation for Native Aortic Regurgitation After Healed Infective Endocarditis

TCTsz Ho Chan SPSamuel Rustem Panday RSRupert Simpson

Key Result

Transfemoral TAVI using the JenaValve Trilogy system with controlled deflection and rotational repositioning resulted in no paravalvular leak and excellent hemodynamic outcome in a 46-year-old patient.

Key Points

To address the challenges of transcatheter aortic valve implantation (TAVI) in patients with severe aortic regurgitation resulting from cusp perforation after infective endocarditis.
A transfemoral TAVI was performed using the JenaValve Trilogy system on a 46-year-old patient with cusp perforation.
Controlled deflection and rotational repositioning techniques were utilized for valve alignment prior to deployment.
Multimodality imaging was implemented to ensure proper positioning of the valve.
No paravalvular leak occurred following valve deployment, indicating successful placement.
Excellent hemodynamic outcomes were achieved, demonstrating the effectiveness of the procedure.
Controlled deflection and repositioning techniques proved critical for safe and stable valve deployment.

Study Design

Type

Case Report (n=1)

Structured PICO

Does transfemoral TAVI using the JenaValve Trilogy system improve hemodynamic outcomes in a patient with severe native aortic regurgitation due to cusp perforation after healed infective endocarditis?

Population

A 46-year-old patient with severe eccentric aortic regurgitation due to cusp perforation after healed infective endocarditis and prohibitive surgical risk.

Intervention

Transfemoral transcatheter aortic valve implantation (TAVI) using the JenaValve Trilogy system with controlled deflection and rotational repositioning.

Outcome

Procedural success (hemodynamic outcome and presence of paravalvular leak)surrogate

Transfemoral TAVI using the JenaValve Trilogy system is feasible and can achieve excellent hemodynamic outcomes without paravalvular leak in patients with severe native aortic regurgitation complicated by cusp perforation.

Abstract

BACKGROUND: Severe native aortic regurgitation due to cusp perforation after healed infective endocarditis presents challenges for transcatheter aortic valve implantation (TAVI), particularly without annular calcification. CASE SUMMARY: A 46-year-old patient with healed infective endocarditis presented with severe eccentric aortic regurgitation due to perforation of the left coronary cusp. Given prohibitive surgical risk, transfemoral TAVI using the JenaValve Trilogy system was performed. Controlled deflection and rotational repositioning enabled coaxial alignment of the valve above the native cusps prior to deployment, resulting in no paravalvular leak and excellent hemodynamic outcome. DISCUSSION: This case highlights the technical challenges of TAVI in aortic regurgitation with cusp perforation and demonstrates how leaflet-locator anchoring, delivery system deflection, and multimodality imaging enable safe and effective valve positioning. TAKE-HOME MESSAGE: Cusp perforation may cause locator misengagement during TAVI; controlled deflection and repositioning are critical to achieve safe, stable deployment.

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Transcatheter Aortic Valve Implantation for Native Aortic Regurgitation After Healed Infective Endocarditis

Key Result

Key Points

Study Design

Structured PICO

Abstract

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