Rehabilitation Course Through Compassionate Use of JenaValve Trilogy Heart Valve System in a Patient With Left Ventricular Assist Device: A Case Study.

Aortic insufficiency (AI) develops in approximately one-third of patients 3 years after continuous-flow left ventricular assist device (LVAD) implantation. Transcatheter aortic valve replacement (TAVR) has recently emerged as a potential option. However, the use of TAVR in patients with LVADs is limited. There are currently only two transcatheter valves, J-Valve and Trilogy Valve, available under expanded access for aortic regurgitation, particularly for patients with LVAD. This case describes a 47 year old male with destination HeartMate 3 LVAD complicated by methicillin-susceptible Staphylococcus aureus bacteremia and severe AI causing cardiogenic shock. Despite inotropic and pharmacologic support, his course was marked by profound deconditioning and fluctuating renal and hepatic function. After a multidisciplinary review, the patient underwent compassionate use of the Trilogy Valve. Post-procedure, he demonstrated marked functional recovery, improving from maximal assistance to independent ambulation, reaching 1,145 feet during 6 minute walk test, and achieving an Activity Measure Post-Acute Care Basic Mobility score of 24/24. The Trilogy Valve is currently under investigation in the ALIGN-AR studies, but has only been used in LVAD patients under compassionate use in the United States. Ongoing registry data (JENA-VAD) and future research are needed to validate procedural standardization, hemodynamic effects, and rehabilitation potential and outcomes in this high-risk population.