Paravalvular Aortic Leak After Transcatheter Aortic Valve Replacement

New Drugs and Technologies 397T ranscatheter aortic valve replacement (TAVR) is now well-established as the standard of care for patients with severe symptomatic aortic stenosis who are deemed inoperable, 1 and is seen as an alternative treatment option to surgical aortic valve replacement (SAVR) in a subset of patients with high postoperative mortality.2 The native valve is typically not removed but instead crushed by the superimposed bioprosthesis, which can result in an incomplete seal of the bioprosthetic valve and aortic annulus, with subsequent occurrence of paravalvular leak (PVL).Two types of Transcatheter Heart Valves (THV) that have been widely used, the balloon-expandable Edwards valve (Cribier-Edwards, Edwards SAPIEN and Edwards SAPIEN XT) by Edwards Lifesciences, and the selfexpandable CoreValve by Medtronic, have been described in detail elsewhere. 3,4Despite the evolving technology of transcatheter valves, PVL post-TAVR is common, with a wide range of reported incidences (Table 1).Most importantly, PVL has been associated with increased short-and long-term mortality post-TAVR, and is seen as a barrier to more widespread use of this promising technique.[5][6][7][8][9][10][11][12][13] This article describes the incidence, causes, and predictors of PVL, as well as its impact on clinical outcomes.Methods of prevention, diagnosis, and treatment of PVL are also reviewed.