Even aortic insufficiency can be treated percutaneously: right?

Moderate or severe aortic insufficiency (AI) is a relatively rare condition but with significant clinical implications, especially in elderly patients at high surgical risk. Although surgical aortic valve replacement remains the gold standard for treatment, a significant proportion of patients are not eligible due to the high surgical risk. In recent years, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of aortic stenosis, but its application to AI has encountered significant challenges, mainly related to specific anatomical characteristics of this population. This review provides an overview of the evolution of the transcatheter treatment of AI, highlighting the critical issues of first-generation TAVI devices and the improvements achieved with new-generation and dedicated devices, such as JenaValve and J-Valve. Preliminary data demonstrate encouraging procedural results, including a reduction in residual insufficiency and improved safety in patients at high surgical risk. However, limitations remain, including the high incidence of pacemaker implantation and the lack of long-term randomized clinical trials. In light of technological advances, TAVI represents a promising therapeutic option for selected patients with AI, if performed in high-volume centres with extensive experience in the treatment of aortic disease.