WATCH: Houston Methodist Expert Highlights Advances in Transcatheter Treatment for Aortic Regurgitation

In a new whiteboard video, Dr. Neil Kleiman, chief of Interventional Cardiology at Houston Methodist Hospital, offers a concise yet comprehensive overview of emerging strategies in the transcatheter treatment of aortic valve regurgitation, an area historically limited to surgical approaches.

While transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis, accounting for more than 100,000 procedures performed annually in the U.S., Kleiman notes that patients with aortic regurgitation (AR) have largely been excluded from this shift in care.

"Until very recently, aortic regurgitation remained strictly in the surgical domain," Dr. Kleiman explains.

AR, although less common than stenosis, is far from benign. Kleiman cites data showing a two-year mortality rate of over 15% in patients with severe untreated AR and up to 75% at five years. Despite this, many eligible patients remain untreated, echoing the early days of TAVR for patients with stenosis.

Part of the challenge is anatomical. Patients with AR often have dilated annuli, enlarged aortic roots and minimal valvular calcification, making standard TAVR devices suboptimal.

"Calcium is your friend in TAVR," says Dr. Kleiman, referring to its role in anchoring the valve. "In cases of aortic regurgitation, there often isn't enough of it."

To address these limitations, two new devices — the JenaValve and J-Valve — have recently been developed specifically for AR. Unlike conventional models, these valves feature locator prongs that anchor the device during diastole by engaging the native cusps and the aortic root.

Early results are promising: A recent meta-analysis led by the Houston Methodist team reported higher procedural success and lower 30-day mortality with the investigational valves compared to off-label use of approved TAVR devices.

The video also spotlights Houston Methodist's clinical trial leadership in this space. Dr. Kleiman's team is currently enrolling patients with pure AR and those with left ventricular assist devices (LVADs) who develop secondary regurgitation. One trial directly compares the JenaValve with surgical valve replacement, mirroring early TAVR-versus-surgery studies for aortic stenosis.

With a growing population of medically complex patients and expanding device innovation, Dr. Kleiman emphasizes that transcatheter options for AR may soon follow the same trajectory as TAVR in aortic stenosis.

"This is a field we're heavily involved in, and one I hope more colleagues across the nation will begin to explore," Dr. Kleiman says.