Why the study?
Aortic regurgitation is progressive and frequently underrecognized, leaving many patients untreated despite Class I indications as diagnostic techniques and surgical or transcatheter treatments rapidly evolve.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It's not uncommon that we might not have the full picture and the capability to quantify how much aortic regurgitation these patients have. What this paper highlights is that we should have a low threshold to consider cardiac MRI up front in the decision-making for these patients.”
“time to evolve to measurement of true LV volumes as the clinical standard rather than relying on the surrogate of LV diameters”
“The investigators are to be congratulated on their seminal work in a field with large unmet clinical needs. The present analysis is the first report on the use of the TF J-Valve platform for treating patients with pure native AR.”
Review highlights current diagnostic methods and treatment strategies for aortic regurgitation, suggesting improved patient outcomes.
Aortic regurgitation (AR) is progressive and frequently underrecognized; without timely intervention it drives adverse left-ventricular remodeling and heart failure. Despite Class I guideline indications, many patients-especially older, frail individuals with multimorbidity-remain untreated. Advancements in high-fidelity multimodality imaging - including cardiac magnetic resonance, four-dimensional flow, and speckle-tracking echocardiography - have enabled earlier detection of remodeling and more accurate quantification of regurgitant burden. These techniques are redefining thresholds for treatment and may enable biomarker-imaging composite staging of disease. Surgery remains the gold standard of therapy for native AR. Contemporary surgical management is tailored to age, anatomy, and root pathology. While surgical aortic valve replacement remains the predominant therapy for most candidates, valve-sparing root procedures, the Ross operation, and aortic valve neocuspidization are increasingly offered at experienced centers for carefully selected lower-risk patients. Transcatheter aortic valve replacement is expanding rapidly as a viable option that helps bridge the treatment gap for those at prohibitive or high risk for surgery. Yet, devices optimized for calcific aortic stenosis encounter technical obstacles in native AR - including large, non-calcified annuli, elliptical root geometry, and high stroke volumes - leading to suboptimal anchoring, residual paravalvular regurgitation, and device embolization. Purpose-built AR systems with leaflet-engaging anchoring and enhanced sealing have shown encouraging outcomes in feasibility and pivotal studies, and have obtained commercial approval in Europe, and U.S. authorization is anticipated. This state-of-the-art review synthesizes current insights into AR pathophysiology, diagnostic advances, and therapeutic innovations in surgical and transcatheter techniques, highlighting knowledge gaps and proposing research priorities to accelerate access to care for this historically undertreated population.
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Pawar et al. (2025) conducted a review in Aortic regurgitation. Surgical and transcatheter techniques was evaluated. Advancements in multimodality imaging and therapeutic innovations, including purpose-built transcatheter systems, are expanding treatment options for patients with aortic regurgitation.
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