Key result
Among 25 patients undergoing TAVR with self-expandable prostheses, paravalvular leak improved by ≥1 grade in 28% of patients before discharge, which was associated with THV frame expansion.
Why the study?
PVL is common after TAVR and affects late outcomes, particularly with self-expandable valves, but little is known about self-expandable THV expansion after implantation.
Does frame expansion of self-expandable transcatheter heart valves reduce paravalvular leak in the early days after TAVR?
Cohort (n=25)
Does frame expansion of self-expandable transcatheter heart valves reduce paravalvular leak in the early days after TAVR?
Paravalvular leak may improve in the early days after TAVR with self-expandable valves, and this improvement is associated with continued frame expansion.
Answers are grounded in this paper and cite their sources.
May support serial imaging for SE-THV expansion; leaves open whether it alters PVL management or outcomes.
BACKGROUND: Paravalvular leakage (PVL) is a common finding after transcatheter aortic valve replacement (TAVR) and affects late clinical outcome. It is more frequent with self-expandable (SE) transcatheter-heart-valve (THV). Few is known about SE-THV expansion after implantation. The purpose is to assess SE-THV frame expansion and its possible influence on PVL. METHODS: We designed a prospective pilot study to assess the time-course of SE-THV frame dimensions and PVL after TAVR. Consecutive patients undergoing TAVR with SE-THV were enrolled. Prosthesis fluoroscopy and echocardiography were prospectively performed immediately after TAVR (T0) and before discharge (T1) to grade PVL. Prosthesis diameters were assessed in 2 fluoroscopic orthogonal views. PVL reduction ≥1+ from T0 to T1 at echocardiography was the primary study endpoint. RESULTS: Twenty-five patients were enrolled. Mean interval between T0 and T1 evaluations was 5 days. Grade 1 or 2 was present in 76% of patients at T0 and in 68% at T1 (P=0.034). A total of 7 patients (28%) improved PVL ≥1 grade from T0 to T1. Differences between T0 and T1 fluoroscopic diameters were not statistically significant. When comparing the diameter changes according to PVL evolution, patients with PVL improvement (as compared with those without) had significantly larger minimum diameter increase at both annulus/inflow (P=0.016) and outflow/distal edge (P=0.027). CONCLUSIONS: PVL may improve in the early days after SE-THV and those patients with PVL improvement may have THV frame expansion. Further studies are needed to confirm such preliminary observations and to establish the clinical relevance of this phenomenon.
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Russo et al. (2023) conducted a cohort in Paravalvular leakage after transcatheter aortic valve replacement (n=25). Self-expandable transcatheter-heart-valve (SE-THV) was evaluated on PVL reduction ≥1+ from T0 to T1 at echocardiography. Among 25 patients undergoing TAVR with self-expandable prostheses, paravalvular leak improved by ≥1 grade in 28% of patients before discharge, which was associated with THV frame expansion.
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