Transapical TAVR Using a Modified J‐Valve for Pure Aortic Regurgitation in Large Aortic Annuli: A Single‐Center Experience

Objective To evaluate the safety and efficacy of transapical implantation of a modified J‐Valve in patients with pure aortic regurgitation (AR) and large aortic annuli (> 29 mm). Methods This retrospective single‐center study included 10 high surgical risk patients (STS‐PROM: 8.3%–13.1%) with pure AR and annular diameters > 29 mm who underwent transapical implantation of a J‐Valve prosthesis externally reinforced with a Dacron patch between December 2018 and September 2024. Endpoints were defined according to the Valve Academic Research Consortium‐3 (VARC‐3) criteria. Procedural outcomes, echocardiographic data, and 30‐day complications were analyzed. Results All procedures were technically successful, with no intraoperative mortality, stroke, or vascular complications. Postoperatively, one patient required permanent pacemaker implantation. Perivalvular leakage (PVL) was observed in five patients (four trace/mild, one moderate) immediately postprocedure. At a median follow‐up of 6.5 months, PVL was present in three patients (two trace, one moderate). Significant reductions in left ventricular dimensions and stable hemodynamic parameters were noted. No subclinical leaflet thrombosis occurred. Conclusions Transapical implantation of a modified J‐Valve with an external Dacron skirt appears technically feasible with acceptable short‐term safety for highly selected high‐risk patients with pure AR and large annuli (> 29 mm). However, the limited sample size precludes broad applicability, and longer term follow‐up is required.