Transcatheter Aortic Valve Implantation for Pure Native Aortic Regurgitation: A Comprehensive State-of-the-Art Review
4 affiliations
- 1Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- 2Division of Cardiology, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- 3Department of Cardiology, Ospedale San Giovanni Bosco, 10154 Turin, Italy
- 4Department of Cardiac Surgery, San Raffaele University Hospital, 20132 Milan, Italy
Abstract
Pure native aortic regurgitation (AR) remains a challenging and frequently undertreated valvular disease, associated with substantial morbidity and mortality. Surgical aortic valve repair or replacement remains the standard of care; however, many patients are older, frail, or at prohibitive surgical risk, creating an unmet need for less invasive therapeutic options. In this context, transcatheter aortic valve implantation (TAVI) has progressively emerged as a potential alternative. However, the application of TAVI in AR has historically been limited by the absence of annular and leaflet calcification, the presence of large and often noncircular annuli, and the resulting risks of transcatheter valve embolization or migration, residual paravalvular regurgitation, and conduction disturbances. This review summarizes contemporary evidence on TAVI for pure native AR, spanning early off-label experience with first-generation self-expanding and balloon-expandable valves to newer-generation platforms and dedicated devices. Recent observational studies and multicenter registries have shown meaningful improvements in procedural success, lower rates of residual AR and second valve implantation, and acceptable short- and mid-term mortality with contemporary off-label devices. Dedicated systems, including JenaValve Trilogy, J-Valve, and others, have further enhanced anchoring and sealing performance, achieving markedly lower rates of valve migration and significant residual regurgitation. Nonetheless, permanent pacemaker implantation remains a major limitation for several platforms. In parallel, the AURORA trial introduced an anatomy-guided strategy based on multidetector computed tomography classification and dual anchoring theory, suggesting that careful anatomical selection and optimized implantation planning may improve outcomes even with non-dedicated devices. Overall, TAVI has become a viable option for selected high-risk patients with severe symptomatic pure native AR and has now been incorporated into contemporary guidelines in this setting. Future progress will likely depend on further refinement of dedicated devices, reduction of conduction-related complications, and broader integration of patient-specific anatomical and biomechanical assessment to optimize device selection and implantation strategy.
Related
- Transcatheter Aortic Valve Implantation in Complex Anatomy: An Anatomy-Driven Framework for Bicuspid Stenosis, Pure Aortic Regurgitation, and the Small Annulus in the Era of Lifetime Management
- Clinical Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Pure Native Aortic Regurgitation: A Systematic Review and Meta-Analysis
- Clinical Impact of Multiple‐Clip Implantation for Residual Mitral Regurgitation After Transcatheter Edge‐to‐Edge Repair
- Coexisting Moderate-to-Severe Tricuspid Regurgitation and Renal Dysfunction Identify a High-Risk Group After Transcatheter Aortic Valve Replacement
- Modified balloon-assisted shoehorn technique for transcatheter aortic valve implantation in functionally horizontal anatomy: a case report
BibTeX
@article{rampone2026transcatheter,
title = {{Transcatheter Aortic Valve Implantation for Pure Native Aortic Regurgitation: A Comprehensive State-of-the-Art Review}},
author = {Joao Matteo Rampone and Samuele Sandrone and Sergio Capoccia and Federico Conrotto and Francesco Bruno and Ovidio De Filippo and Mario Iannaccone and Giacomo Boccuzzi and Fabrizio D’Ascenzo and Francesco Maisano and Gaetano Maria De Ferrari and Federico Giacobbe},
journal = {Reviews in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.31083/rcm54189},
url = {https://doi.org/10.31083/rcm54189},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Transcatheter Aortic Valve Implantation for Pure Native Aortic Regurgitation: A Comprehensive State-of-the-Art Review
AU - Joao Matteo Rampone
AU - Samuele Sandrone
AU - Sergio Capoccia
AU - Federico Conrotto
AU - Francesco Bruno
AU - Ovidio De Filippo
AU - Mario Iannaccone
AU - Giacomo Boccuzzi
AU - Fabrizio D’Ascenzo
AU - Francesco Maisano
AU - Gaetano Maria De Ferrari
AU - Federico Giacobbe
PY - 2026
DA - 2026/10/22
JO - Reviews in Cardiovascular Medicine
DO - 10.31083/rcm54189
UR - https://doi.org/10.31083/rcm54189
AB - Pure native aortic regurgitation (AR) remains a challenging and frequently undertreated valvular disease, associated with substantial morbidity and mortality. Surgical aortic valve repair or replacement remains the standard of care; however, many patients are older, frail, or at prohibitive surgical risk, creating an unmet need for less invasive therapeutic options. In this context, transcatheter aortic valve implantation (TAVI) has progressively emerged as a potential alternative. However, the application of TAVI in AR has historically been limited by the absence of annular and leaflet calcification, the presence of large and often noncircular annuli, and the resulting risks of transcatheter valve embolization or migration, residual paravalvular regurgitation, and conduction disturbances. This review summarizes contemporary evidence on TAVI for pure native AR, spanning early off-label experience with first-generation self-expanding and balloon-expandable valves to newer-generation platforms and dedicated devices. Recent observational studies and multicenter registries have shown meaningful improvements in procedural success, lower rates of residual AR and second valve implantation, and acceptable short- and mid-term mortality with contemporary off-label devices. Dedicated systems, including JenaValve Trilogy, J-Valve, and others, have further enhanced anchoring and sealing performance, achieving markedly lower rates of valve migration and significant residual regurgitation. Nonetheless, permanent pacemaker implantation remains a major limitation for several platforms. In parallel, the AURORA trial introduced an anatomy-guided strategy based on multidetector computed tomography classification and dual anchoring theory, suggesting that careful anatomical selection and optimized implantation planning may improve outcomes even with non-dedicated devices. Overall, TAVI has become a viable option for selected high-risk patients with severe symptomatic pure native AR and has now been incorporated into contemporary guidelines in this setting. Future progress will likely depend on further refinement of dedicated devices, reduction of conduction-related complications, and broader integration of patient-specific anatomical and biomechanical assessment to optimize device selection and implantation strategy.
SN - 1530-6550
SN - 2153-8174
ER -