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Aortic regurgitation after transcatheter aortic valve replacement
Nikos Werner1, Jan-Malte Sinning
1Heart Center Bonn, Department of Medicine II, University Hospital Bonn.
Summary
Paravalvular aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) impacts patient outcomes. Multimodal imaging and hemodynamic assessment are crucial for accurate AR severity quantification post-TAVR.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Paravalvular aortic regurgitation (AR) is a significant complication after transcatheter aortic valve replacement (TAVR), negatively impacting patient prognosis.
- Causes of AR include incomplete stent frame expansion due to annular calcifications, suboptimal prosthesis placement, and annulus-prosthesis size mismatch, all increasing mortality risk.
Purpose of the Study:
- To highlight the challenges in quantifying AR after TAVR.
- To emphasize the utility of a multimodal approach combining echocardiography, hemodynamic measurements, and other imaging modalities for precise AR severity assessment.
- To review the performance of next-generation transcatheter heart valves (THVs) regarding paravalvular AR.
Main Methods:
- Echocardiography is essential for differentiating between transvalvular and paravalvular AR and identifying etiologies.
- A multimodal strategy integrating hemodynamic data and various imaging techniques is recommended for accurate AR quantification.
- Evaluation of outcomes associated with next-generation THVs, focusing on design modifications aimed at reducing paravalvular AR.
Main Results:
- Echocardiographic quantification of AR in TAVR patients presents challenges, particularly during the implantation procedure.
- A multimodal approach provides a more precise assessment of AR severity immediately after valve deployment.
- Early data on next-generation THVs suggest a reduced incidence of paravalvular AR due to design innovations like space-fillers and repositionability.
Conclusions:
- Accurate assessment of paravalvular AR is critical for improving TAVR outcomes.
- A comprehensive evaluation strategy is necessary to overcome the limitations of individual imaging modalities.
- Next-generation THVs show promise in mitigating paravalvular AR, potentially leading to better long-term results.
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