Aortic regurgitation (AR) has long been the valvular lesion left behind by the transcatheter revolution — but that changed in 2026. Registry data underscore the problem the field faces: untreated severe AR carries substantial two-year mortality (around 20%), yet rates of Heart Valve Team evaluation and aortic valve replacement remain low, arguing for earlier referral and intervention.
The landmark development is the FDA approval of the JenaValve Trilogy system in 2026 — the first transcatheter heart valve approved for symptomatic severe AR (in patients at high surgical risk), on the strength of the ALIGN-AR trial. This matters because conventional TAVR valves rely on annular calcification to anchor, which is typically absent in AR; the Trilogy uses locators that attach directly to the native leaflets, enabling stable implantation in non-calcified valves. Surgical aortic valve replacement remains the standard for suitable surgical candidates, and other dedicated AR devices (such as the J-Valve) are in trials. Echocardiography remains the primary imaging modality, with cardiac MRI, left ventricular end-systolic volume index, and global longitudinal strain increasingly used to refine the timing of intervention.
Further reading: clinical journey of AR patients (Amoroso et al., 2024); AR from mechanisms to management (Baumbach et al., EuroIntervention 2024); JenaValve Trilogy ALIGN-AR trial and 2026 FDA approval.