Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement: Is the Problem Solved?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology

Background:

• Paravalvular regurgitation (PVR) is a frequent complication following transcatheter aortic valve replacement (TAVR).
• The severity of PVR correlates with adverse patient outcomes, including a >2-fold increase in mortality.
• Despite advances in TAVR technology and techniques, moderate to severe PVR still affects 2-7% of patients.

Purpose of the Study:

• To provide a comprehensive overview of current strategies for paravalvular regurgitation.
• To outline methods for preventing PVR through optimized patient selection, valve sizing, and implantation.
• To detail the detection, quantification, and management of PVR during and after TAVR procedures.

Main Methods:

• Review of current literature and state-of-the-art approaches.
• Analysis of techniques for optimizing TAVR procedures to minimize PVR.
• Discussion of diagnostic modalities for PVR assessment and therapeutic interventions.

Main Results:

• Optimized patient selection, precise valve sizing, and accurate implantation positioning are crucial for PVR prevention.
• Early and accurate detection and quantification of PVR are essential for timely management.
• Various management strategies exist for PVR, tailored to its severity and clinical impact.

Conclusions:

• Effective prevention of paravalvular regurgitation is achievable through meticulous procedural planning and execution.
• Timely diagnosis and appropriate management of PVR are critical for mitigating associated risks and improving TAVR outcomes.
• This review offers a practical guide for clinicians managing PVR in TAVR patients.