By Dr Edgar Tay. Reviewed by Dr Edgar Tay, interventional cardiologist and structural heart specialist at Asian Heart & Vascular Centre. Last reviewed July 2026.
Reading time: about 6 minutes.
TL;DR
Aortic regurgitation is a leaking aortic valve, where blood flows backwards into the heart’s main pumping chamber with each beat. It can stay silent for years, then strain the left ventricle. The decision to treat rests on four things: whether you have symptoms, how severe the leak is, how well the heart is coping, and how a chosen valve fits your life long term. Surgery remains the standard for most patients who are fit for it, but for selected higher-risk patients a newer keyhole option has arrived: in March 2026 the JenaValve Trilogy became the first transcatheter valve approved by the US FDA specifically for aortic regurgitation.
What a leaking aortic valve is, and why it matters
The aortic valve is the door between the heart’s main pumping chamber, the left ventricle, and the aorta, the large artery carrying blood to the body. In aortic regurgitation (a leaking aortic valve), it does not seal, so a portion of blood flows backwards into the ventricle with each beat. The leak can come from the valve leaflets themselves, such as a bicuspid valve, or from stretching of the aortic root that pulls the leaflets apart.
The ventricle compensates for years by enlarging, which is why many people have no symptoms early, and the leak is first heard as a murmur or found on a scan. That adaptation is not free: sustained overload eventually weakens the heart muscle, and once that decline sets in, part of it can be permanent. The point of monitoring is to act before that stage, not after it.
Do you need treatment now? The four questions your cardiologist works through
Timing is the real question in aortic regurgitation, answered by weighing four things rather than any single test.
1. Do you have symptoms? Symptoms are one of the strongest signals that the valve needs attention. Breathlessness on exertion, chest discomfort, unusual fatigue, or reduced exercise tolerance suggest compensation is running out. Once severe aortic regurgitation causes symptoms, both the European and American guidelines recommend valve surgery regardless of the pumping fraction, provided operative risk is acceptable.
2. How severe is the leak? Mild or moderate regurgitation is often monitored rather than treated, so the degree matters. An echocardiogram (a heart ultrasound) is the first tool; when it is inconclusive, a cardiac MRI measures the leak more precisely as the regurgitant fraction, where roughly 50% or more indicates severe regurgitation. The treatment decision is only as sound as the measurement behind it, so an experienced imaging team matters.
3. How well is the heart coping? The same imaging shows whether the left ventricle is starting to struggle, seen as enlargement of the chamber and a fall in pumping strength. Guidelines put numbers on this: surgery is advised even without symptoms once the ejection fraction falls to around 50% or below, or the chamber’s end-systolic diameter passes about 50mm. The American guideline moves earlier, at an ejection fraction below 55%. A steady worsening across serial scans, even within the normal range, is itself a reason to act.
4. Will the valve last, and what happens when it wears out? This is the question patients ask least and should ask most. Any replacement valve has a working life, so the right choice depends on your age and health, and on whether a future procedure might be needed. That planning is part of the decision from the start.
Treatment options for aortic regurgitation
Medication does not fix a leaking valve. It can help control blood pressure and support the heart, but it does not reverse the regurgitation or stop the ventricle enlarging. It is a supporting measure, not a definitive treatment.
Conventional surgery is the most common definitive treatment and the standard for patients at acceptable operative risk. The surgeon replaces the valve with a mechanical or tissue valve, or in selected cases repairs the patient’s own valve where the anatomy allows. It is also the natural choice when the aorta is enlarged: a dilated aortic root or ascending aorta can be replaced in the same operation, avoiding a second procedure later.
Transcatheter aortic valve implantation (TAVI) delivers a new valve through a catheter passed up from an artery in the groin, without opening the chest. TAVI is well established for a narrowed valve (aortic stenosis), but a leaking valve is a harder problem, which is where the newest development comes in.
The latest development: TAVI for aortic regurgitation, and the JenaValve
For years, a pure leaking valve was considered unsuitable for standard TAVI. Conventional TAVI valves anchor against a stiff, calcium-laden valve, and most regurgitant valves have little calcium to grip, so a standard device can shift or leak around the edges. This is a genuine limitation, worth knowing before assuming a keyhole option is open to everyone.
A new generation of valves was designed for this problem, using clips or locators that grasp the patient’s own leaflets to hold the device in place without relying on calcium. The JenaValve Trilogy is furthest along: in March 2026 it became the first, and to date only, transcatheter valve approved by the US Food and Drug Administration for symptomatic, severe native aortic regurgitation, in patients judged by a Heart Team to be at high or greater surgical risk. In its pivotal ALIGN-AR trial, 92% of treated patients were in the two mildest heart-failure categories at one year, a marked improvement from baseline. Other dedicated valves are progressing in parallel: the J-Valve is approved for aortic regurgitation in China, while the Hanchor Valve and the Ken-Valve remain under evaluation.
Two honest caveats belong here. First, the long-term durability of these newer valves is not yet established, which is why they are reserved for patients at higher surgical risk rather than offered as a routine alternative to surgery; younger, lower-risk patients generally do better with surgical repair or replacement. Second, availability in Singapore depends on Health Sciences Authority approval and adoption by local centres, so eligibility is assessed case by case. Whether TAVI is technically suitable is determined by a detailed CT scan of the valve and aorta before any decision is made.
Lifetime management: choosing a valve that fits your life
The choice of valve is really a choice about the years after the procedure. A mechanical valve is highly durable and can last decades, but requires lifelong blood-thinning medication and its bleeding risk. A tissue valve avoids long-term blood thinners for most patients but wears out sooner, typically over 10 to 20 years, and faster in younger people. Mechanical valves are therefore generally favoured in younger patients and tissue valves in older ones, with the middle years decided individually. What happens later matters too: a worn tissue valve can often be treated by placing a new valve inside the old one through a catheter, avoiding a second open operation in suitable patients. These decisions are made with a Heart Team, weighing your age, health, and preferences, rather than by a single rule.
Frequently asked questions
1. What is aortic regurgitation?
Aortic regurgitation is a leaking aortic valve. The valve between the heart’s main pumping chamber and the aorta does not close tightly, so blood flows backwards with each beat. Over time, this overloads and enlarges the left ventricle, which is why it is monitored even when it causes no symptoms.
2. Do I need surgery for aortic regurgitation straight away?
Not always. Mild or moderate leaks are usually monitored rather than treated. Treatment is recommended when severe regurgitation causes symptoms, or when scans show the left ventricle enlarging or weakening beyond set thresholds. Your cardiologist weighs symptoms, the severity of the leak, and how the heart is coping before advising surgery.
3. What are the symptoms of a leaking aortic valve?
Many people have no symptoms for years. When they appear, they include breathlessness on exertion, reduced exercise tolerance, unusual tiredness, chest discomfort, and occasionally palpitations. Because symptoms arrive late, regular echocardiograms matter even when you feel well, so treatment can be timed before the heart is affected.
4. Can aortic regurgitation be treated without open-heart surgery?
For selected higher-risk patients, yes. In March 2026, the JenaValve Trilogy became the first transcatheter valve approved by the US FDA for aortic regurgitation, delivered through a catheter without opening the chest. It is currently intended for patients at high surgical risk, and suitability depends on a detailed CT scan and on availability in Singapore.
5. Which type of replacement valve is best, mechanical or tissue?
Neither is best for everyone. Mechanical valves last longer but require lifelong blood-thinning medication; tissue valves avoid long-term blood thinners for most people but wear out sooner, typically over 10 to 20 years. They are chosen individually by the Heart Team, with mechanical valves generally favoured in younger patients and tissue valves in older ones.
6. Which doctor treats aortic regurgitation in Singapore?
A leaking aortic valve is assessed by a cardiologist, and where a valve procedure is considered, a structural heart specialist leads the plan with a cardiac surgeon in a Heart Team. At Asian Heart & Vascular Centre, Dr Edgar Tay, interventional cardiologist and structural heart specialist, oversees the assessment and transcatheter treatment of aortic valve disease.
7. Has TAVI for aortic regurgitation been studied in Asian patients?
Yes. A 2021 review of 274 Asian patients with pure aortic regurgitation treated by transcatheter valve replacement reported device success in 94.9%, and a Singapore TAVI series co-authored by Dr Edgar Tay reported outcomes to two years. Valve sizing and anatomy can differ in Asian patients, which is one reason assessment by a team familiar with this data matters.
8. My father was told he is too high-risk for open-heart surgery. What are his options?
Age alone does not rule out treatment. For patients judged by a Heart Team to be at high surgical risk, the JenaValve Trilogy is now an FDA-approved option delivered through a catheter without opening the chest. Suitability is assessed on a case-by-case basis using a detailed CT scan, and if a transcatheter valve is not technically suitable, the Heart Team advises on the safest alternative.
If you or a family member has been told about a leaking aortic valve, a consultation with Dr Edgar Tay at Asian Heart & Vascular Centre can establish how severe it is, whether it needs treatment now, and which of the surgical and transcatheter options fits your specific situation.
References
- Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal. 2022;43(7):561-632. doi:10.1093/eurheartj/ehab395
- Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227. doi:10.1161/CIR.0000000000000923
- Makkar RR, Thourani VH, Vahl TP, et al. Transcatheter aortic valve implantation with the Trilogy valve for symptomatic native aortic regurgitation (ALIGN-AR): a pivotal, multicentre, single-arm, investigational device exemption study. The Lancet. 2025;406(10521):2757-2771. doi:10.1016/S0140-6736(25)02215-9
- JenaValve Technology. JenaValve announces FDA premarket approval of the Trilogy Transcatheter Heart Valve System. 18 March 2026. jenavalve.com (Accessed 21 July 2026)
- Guddeti RR, et al. Transcatheter aortic valve replacement for native aortic regurgitation: a contemporary review. 2025. PMC12570037 (Accessed 21 July 2026)
- Genesis MedTech. J-Valve TF approved by NMPA: China’s first transfemoral TAVR for aortic regurgitation. September 2025. genesismedtech.com (Accessed 21 July 2026)
- Shanghai Hanlin Medical Device. Hanchor Valve Transcatheter Aortic Valve System granted NMPA innovative-device approval. 24 June 2026. hlongmed.com (Accessed 21 July 2026)
- Transcatheter aortic valve replacement for pure aortic regurgitation in Asian patients. AsiaIntervention. 2021. PMC8670568
- Mid-term study of transcatheter aortic valve implantation in an Asian population. Singapore Medical Journal. 2017. PubMed 27516113
Reviewed by
This article was reviewed by Dr Edgar Tay, interventional cardiologist and structural heart specialist at Asian Heart & Vascular Centre. Dr Tay focuses clinically on structural and valve interventions, including transcatheter aortic valve implantation (TAVI), MitraClip, and related minimally invasive alternatives to open-heart surgery.
Last reviewed July 2026. Information in this article reflects clinical evidence and guidelines current at the time of writing. Consult your cardiologist for advice specific to your individual circumstances.