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Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
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Paravalvular leak after transcatheter aortic valve replacement: Avoid it or treat it if you can!

Arnav Kumar1, Peter C Block1

  • 1Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|November 20, 2018
PubMed

Insights

Paravalvular leaks (PVL) were more frequent with Medtronic Core Valves (MCV) than Edward Sapien Valves (ESV) post-TAVR. PVL improved over time in MCV, particularly between the noncoronary and right coronary cusps, but not in ESV.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Prosthetic Heart Valves

Background:

  • Transcatheter aortic valve replacement (TAVR) is a key treatment for aortic stenosis.
  • Paravalvular leaks (PVL) are a known complication following TAVR.
  • Comparing the performance of different TAVR valve prostheses regarding PVL is crucial for clinical decision-making.

Discussion:

  • Medtronic Core Valves (MCV) initially showed higher rates and severity of PVL compared to Edward Sapien Valves (ESV) immediately post-TAVR.
  • PVL in MCV demonstrated significant improvement over time, unlike in ESV.
  • The reduction in PVL for MCV was notably earlier and more pronounced in the commissural area between the noncoronary cusp (NCC) and right coronary cusp (RCC).

Key Insights:

  • MCV exhibit a dynamic PVL profile, with substantial improvement over time.
  • ESV demonstrate a more static PVL profile without significant improvement post-TAVR.
  • The specific anatomical region (NCC-RCC commissure) plays a role in the differential PVL reduction observed with MCV.

Outlook:

  • Further investigation into the biomechanical properties of MCV may elucidate the mechanisms behind preferential PVL reduction.
  • Long-term follow-up studies are needed to confirm the sustained efficacy of MCV in mitigating PVL.
  • These findings may influence the selection of TAVR prostheses based on patient anatomy and risk of PVL.

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