Introduction
Transcatheter aortic valve replacement (TAVR) has rapidly become a therapy for severe aortic stenosis (AS) in elderly patients1, 2. There is a growing number of elderly patients with a high-risk profile suffering from aortic valve regurgitation (AR) and an abysmal poor prognosis with medical treatment3. However, there are still some challenges in treating AR with TAVR due to the increased risk of valve embolization, migration and paravalvular leakage (PVL) in the absence of aortic annular calcification. Despite surgical aortic valve replacement (SAVR) being the gold standard for treating AR 1, with an annual mortality rate of 10-20% 4, 5, a few elderly patients refuse surgical operations due to the involved surgical risk3.
The initial application of TAVR for AR using first-generation transcatheter heart valve (THV) showed high rates of procedural complications and low device success rates 6, 7. With the evolution of THV design, technical improvements were made to overcome the procedural challenges in treating AR. The J-Valve is a self-expanding, porcine aortic valve stitched within a nitinol frame. Novel features of the THV are its 2-piece structure, longitudinal anchoring mechanism, and automatic anatomical ability to reposition8. Previous research has demonstrated low mortality and stroke and excellent hemodynamics 9, 10.
In 2017, the clinical application of J-Valve was approved by the China Food and Drug Administration for AS and AR patients. TAVR treatment for AR has not yet been validated for a large-scale clinical application. Herein, we report our 1-year institutional experience with transapical TAVR using the J-Valve for the treatment of pure AR patients.