Transcatheter aortic valve replacement for older patients with isolated aortic regurgitation

Aortic regurgitation (AR) poses distinct challenges in interventional cardiology, necessitating novel approaches for treatment. This editorial examined the evolving landscape of transcatheter aortic valve replacement (TAVR) as an alternative therapeutic strategy for AR, particularly in patients deemed high risk for surgery. We explored the anatomical and pathophysiological disparities between AR and aortic stenosis (AS) and elucidates the technical nuances of TAVR procedures in AR patients, emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume. Additionally, we discussed the safety and efficacy of TAVR compared to SAVR in AR management, drawing insights from recent case series and registry data. Notably, dedicated TAVR devices tailored for AR, such as the J-Valve and JenaValve, demonstrate promising outcomes in reducing residual AR and ensuring procedural success. Conversely, “off-label” TAVR devices, including balloon-expandable and self-expandable platforms, offer feasible alternatives–particularly for large aortic annuli–with favorable device success rates and low residual AR rates. We highlighted the need for further research, including randomized trials, to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes. In conclusion, TAVR emerges as a viable option for patients with AR, particularly those facing high surgical risks or frailty, with ongoing investigations poised to refine its position in the therapeutic armamentarium.