SamDawkins Consultant Cardiologist

TAVI for Aortic Regurgitation

For most patients with severe symptomatic aortic regurgitation, open-heart surgery remains the gold standard. For patients who are at increased risk for surgery — for example because of age, frailty, prior cardiac surgery, or significant medical comorbidities — a transcatheter alternative is now available, using a dedicated AR device.

Why standard TAVI is not enough for aortic regurgitation

Conventional TAVI valves (balloon-expandable or self-expanding) rely on calcium in the native aortic valve to anchor the new valve in place. In aortic stenosis, that calcium is plentiful. In pure aortic regurgitation, the valve is typically not calcified — and the aortic root is often dilated rather than tight. Conventional TAVI valves placed into a non-calcified, dilated root tend to migrate, embolise, or leak around the side. For this reason, dedicated AR devices have been developed.

The JenaValve Trilogy

The JenaValve Trilogy (JenaValve Technology) is a self-expanding bioprosthetic valve specifically designed for aortic regurgitation. It has three “locator” arms that grip each of the native valve leaflets, locking the new valve in place independently of any calcium. The Trilogy is commercially available for the treatment of aortic regurgitation.

The J-Valve

The J-Valve (JC Medical) uses a similar leaflet-clamping concept — three “graspers” sit over the native leaflets and the new valve is deployed within them, anchored by the clamping action. The J-Valve is also commercially available for aortic regurgitation in patients at increased surgical risk.

How is TAVI for aortic regurgitation performed?

The procedure is similar in flow to standard TAVI:

  • Carried out under general anaesthetic, with transoesophageal echocardiography (TOE) guidance throughout.
  • The new valve is delivered through one of the femoral arteries in the groin.
  • The locator arms (JenaValve) or graspers (J-Valve) are positioned across the native leaflets.
  • The new valve is deployed inside the locators, locking against the native leaflets.
  • After deployment, the valve is checked carefully on TOE and angiography to confirm normal function and absence of paravalvular leak.

Most patients stay in hospital for 1 to 2 nights and return home walking. Follow-up is at one month, with serial echocardiograms thereafter.

Who is suitable?

These devices are reserved for patients with severe symptomatic aortic regurgitation in whom open-heart surgery is felt to carry too high a risk. Suitability depends on:

  • The mechanism and severity of the leak
  • The size and shape of the aortic root
  • The condition of the left ventricle
  • Vascular access (the size of the leg arteries)
  • Coronary anatomy

Every patient is reviewed in the structural valve multidisciplinary team meeting before a procedure is offered.

Dr Dawkins’s experience

Dr Dawkins is one of a small number of UK operators implanting both the JenaValve Trilogy and the J-Valve for severe aortic regurgitation. Patients are routinely accepted from across the UK and from international referrals. The procedure is carried out at Cleveland Clinic London with a structural multidisciplinary team and a TOE imaging cardiologist guiding every case.