Work

Transcatheter aortic valve replacement with JenaValve Trilogy system for aortic regurgitation following a David procedure: a case report

Year: 2025

Type: article

Abstract: Background: Valve-sparing aortic root replacement (VSARR), also known as the David procedure, is a preferred surgical option for patients with aortic root aneurysms, offering preservation of the native valve and avoidance of mechanical valve replacement with lifelong anticoagulation. However, long-term durability remains a concern, with progressive aortic regurgitation (AR) occurring in up to 20% of cases. Redo surgical valve replacement is standard for failed VSARR, but transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative for high-risk patients, despite technical challenges in non-calcified anatomy. This case highlights the first reported use of the JenaValve Trilogy system to treat post-David procedure AR. Case summary: A 71-year-old female developed severe AR ten years after undergoing a David procedure for a sinus of Valsalva aneurysm. Echocardiography showed eccentric AR due to left and non-coronary cusp malcoaptation, with an effective regurgitant orifice of 0.28 cm². Due to comorbidities and patient preference, TAVR was selected over surgical redo. A 23-mm Trilogy JenaValve was implanted via transfemoral access under conscious sedation. Post-procedural aortogram confirmed successful deployment and absence of residual regurgitation. The patient recovered uneventfully and was discharged on postoperative day five. Discussion: This case demonstrates the feasibility of the JenaValve Trilogy for managing post-VSARR AR, even in the absence of annular calcification. Its unique anchoring mechanism, which uses locators positioned within the sinuses, provides secure fixation in complex anatomies. This leaflet-locating design may offer a transcatheter option for patients with non-calcified anatomy. While promising, further clinical experience and long-term data are needed to better define the role of this system in failed valve-sparing repairs.

Source: European Heart Journal - Case Reports

DOI: 10.1093/ehjcr/ytaf450

Authors: Jeng-Wei Chen, Tsung-Yo Ko, Ying-Hsien Chen, Chih-Yang Chan, Mao-Shin Lin

Institution: National Taiwan University Hospital

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $815