ESC/EACTS Valvular Heart Disease Guidelines Address TAVR for Aortic Regurgitation

September 12, 2025—Updated guidelines on valvular heart disease have been published by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). ESC announced the publication at the 2025 European Society of Cardiology Congress, which was held August 29 to September 1 in Madrid, Spain.

The 2025 ESC/EACTS guidelines for the management of valvular heart disease were published by Fabian Praz, MD, et al in European Heart Journal.

According to ESC, the guidelines give updated recommendations about when less-invasive techniques, such as transcatheter aortic valve replacement (TAVR) or minimally invasive mitral valve surgery, should be used to treat heart valve disease. The updated guidance draws on recently published research findings, including those from large randomized controlled trials, noted ESC.

Section 7 of the guidelines, which address aortic regurgitation (AR), includes a Class IIb recommendation for TAVR as a treatment option at experienced centers for selected patients with AR who are ineligible for surgery.

However, the guidelines noted the following:

• The use of nondedicated transcatheter valves for this indication is off-label and associated with an increased risk of valve malpositioning and residual AR, with consecutively higher rates of second valve implantation (approximately 10%) or surgical conversion, as compared with TAVR in aortic stenosis.
• Dedicated devices appear to minimize the risk of valve migration and residual AR in selected patients but are associated with a high new permanent pacemaker implantation rate (24%).

In a separate announcement, JenaValve Technology, Inc., developer of the Trilogy transcatheter heart valve (THV) system, stated that this is the first formal recommendation for TAVR in AR guidelines.

JenaValve noted that Trilogy is a TAVR device approved in Europe with an indication for treating AR. The company announced the approval and launch of the device in Europe in 2021.

The company noted that the ALIGN-AR pivotal trial for the Trilogy THV system helped inform the updated guidelines with two papers using ALIGN-AR data cited in support of the recommendation, stated JenaValve. In March 2024, the company announced that the ALIGN-AR results were published by Torsten P. Vahl, MD, et al in The Lancet.

“The updated guidelines bring important focus to improving care for patients with AR,” commented Professor Stephan Baldus, MD, in JenaValve’s press release.

Prof. Baldus, who is with Cologne University Hospital in Cologne, Germany, continued, “As interventional cardiologists, our priority is ensuring patients have access to therapies that can change and save their lives. It’s encouraging to see these guidelines acknowledge such a vulnerable population, and Trilogy’s dedicated indication is helping to advance the field and expand treatment options.”