Determinants of Significant Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Abstract

Our study shows that the occurrence of AR >or=2/4 is related to prosthesis/annulus discongruence even after adjustment for experience. Hence, to minimize paravalvular AR, appropriate annular measurements and prosthesis sizing are critical.

Two-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement

“…The factors that underlie paravalvular aortic regurgitation include the ratio of the transcathetervalve size to the size of the annulus, the position of the prosthetic valve, and the pattern of calcification in the native valve. [29][30][31][32] In the PARTNER trial, the valve cover index, 32 defined as 100 × [(valve prosthesis diameter − annulus diameter) ÷ valve prosthesis diameter], was lower in patients with paravalvular aortic regurgitation, implicating systematic valve undersizing as an important causative factor. Recently, the routine use of threedimensional imaging techniques has improved annulus sizing, resulting in better selection of properly sized valves.…”

Paravalvular leak after transcatheter aortic valve implantation (TAVI): Short-term results. Data from Polish national POL-TAVI registry

“…Only Edwards Sapien, Ewards Sapien XT (Edwards Sapien, Irvine, United States) and Medtronic CoreValve (Medtronic CoreValve, Santa Rosa, United States) devices were used in this subset of patients. PVL at hospital discharge was graded as absent or mild, moderate and severe, according to the Valve Academic Research Consortium-2 (VARC 2) criteria with the use of transthoracic echocardiography [6]. We divided patients according to PVL degree into group PVL no higher than mild (no + mild), and at least moderate (moderate + severe).…”

Pros and cons of transcatheter aortic valve implantation (TAVI)

“…A French registry reported an incidence of any degree of PVL post TAVR as high as 60%, while most of the European registries correlated proportionally the degree of PVL with 1-year mortality (3,4). Efforts to recognize patients at a higher risk of PVL based on multi-imaging analysis have shown predictors of significant PVL to include: (I) valve undersizing; (II) device malpositioning; and (III) incomplete valve contact to the native aortic annulus, most often due to extensive and/or eccentric annular calcification (5)(6)(7)(8). Interpretation of different trials and registries is difficult due to intra and inter-institutional variability in the timing, assessment and quantification of PVL.…”