Transcatheter aortic valve replacement with JenaValve Trilogy system for aortic regurgitation following a David...

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.

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.

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.