Aortic Regurgitation in Challenging Anatomy

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Aortic Regurgitation (n=1). Intervention: Transcatheter aortic valve implantation (JenaValve Trilogy). Primary outcome: Procedural success and residual aortic regurgitation.

Q: What does this research mean for the field?

Transcatheter aortic valve implantation with a dedicated device is technically feasible and can achieve effective coaxial deployment without significant paravalvular leak in patients with severe aortic regurgitation caused by post-infective endocarditis leaflet perforation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Marlon V. Gatuz; Taishi Okuno

doi:10.1016/j.jaccas.2026.109557

August 1, 2026JACC Case ReportsOpen Access

Aortic Regurgitation in Challenging Anatomy

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Key result

Dedicated TAVI achieves procedural success with no paravalvular leak in post-endocarditis aortic regurgitation.

n=1

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Transcatheter aortic valve implantation for pure native aortic regurgitation is challenging due to anatomical variability and limited data on dedicated AR devices in complex AR types and postendocarditis cases.

Key Points

To examine the expanding role, procedural hurdles, and anatomical boundaries of dedicated transcatheter aortic valve implantation devices in complex aortic regurgitation.
Synthesized evidence from dedicated device trials, including the ALIGN-AR pivotal trial and the ongoing randomized ARTIST trial (NCT06608823).
Evaluated procedural reports and multicenter registry data regarding transcatheter valve deployment for post-infective endocarditis lesions and focal cusp perforations.
In the ALIGN-AR trial (N=700 high-risk patients), the JenaValve Trilogy demonstrated 95% technical success, 1.6% 30-day mortality, and 0.5% moderate with 0% severe residual aortic regurgitation at 30 days.
A multicenter registry of healed infective endocarditis (n=54) treated primarily with stenosis-designed devices reported an 11.1% 1-year mortality, 27.9% moderate or greater residual aortic regurgitation, and a 1.8% reinfection rate.
Active catheter deflection uniquely enabled recovery and symmetric realignment following locator misengagement into isolated cusp perforations (type Id aortic regurgitation).

PICO

P

Population

A 46-year-old man with severe symptomatic aortic regurgitation due to post-endocarditis isolated left coronary cusp perforation who underwent transcatheter aortic valve implantation.

I

Intervention / Comparator

Transcatheter aortic valve implantation (JenaValve Trilogy) (25 mm)

O

Primary Outcome

Procedural success and residual aortic regurgitation

Limitations

Durability of dedicated AR devices in young patients is unstudied.
Long-term durability of leaflet-based anchoring remains unknown.
Risk of prosthetic valve endocarditis after dual-organism infective endocarditis is not negligible.
Possibility of indolent residual infection cannot be fully excluded even after a full course of antibiotics.

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Implication

Review reveals the utility of dedicated transcatheter devices in complex aortic regurgitation, indicating expanding minimally invasive options for high-risk valve defects.

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Cite This Study

Gatuz et al. (2026) conducted an editorial in Aortic Regurgitation (n=1). Transcatheter aortic valve implantation (JenaValve Trilogy) was evaluated on Procedural success and residual aortic regurgitation. Transcatheter aortic valve implantation using a dedicated device was technically feasible and resulted in no paravalvular leak in a patient with severe aortic regurgitation due to post-endocarditis leaflet perforation.

synapsesocial.com/papers/6a9af5d42eef64bdd5aa65dd https://doi.org/10.1016/j.jaccas.2026.109557

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Aortic Regurgitation in Challenging Anatomy

Key Points

PICO

Limitations

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Implication

Abstract

Discussion

Cite This Study

Aortic Regurgitation in Challenging Anatomy

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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