Why the study?
To describe a step-by-step approach to transcatheter paravalvular leak closure after TAVR using frame-based access through a self-expanding valve.
Does transcatheter paravalvular leak closure using frame-based access through a self-expanding valve improve paravalvular regurgitation and clinical symptoms in patients with post-TAVR PVL?
Does transcatheter paravalvular leak closure using frame-based access through a self-expanding valve improve paravalvular regurgitation and clinical symptoms in patients with post-TAVR PVL?
Preprocedural computed tomography planning can identify favorable frame-based access routes through misaligned cells of self-expanding TAVR valves to successfully close challenging paravalvular leaks.
Answers are grounded in this paper and cite their sources.
May offer feasible frame-based access for post-TAVR PVL; leaves open generalizability, safety, and outcomes versus alternatives.
OBJECTIVE: To describe a step-by-step approach to transcatheter paravalvular leak (PVL) closure after transcatheter aortic valve replacement (TAVR) using frame-based access through a self-expanding valve. KEY STEPS: An 85-year-old man with a 34-mm Evolut FX+ TAVR valve developed worsening heart failure. Multimodality imaging showed moderate to severe PVL with adverse left ventricular remodeling. Preprocedural computed tomography localized a dominant jet aligned with a misaligned diamond-shaped cell of the Evolut valve. A closure device was delivered through this cell, markedly reducing PVL. POTENTIAL PITFALLS: Inadequate multimodality imaging may cause incorrect leak localization, device malposition, or longer procedures. Challenges include crossing the PVL tract within the valve frame and avoiding leaflet interference. Balloon postdilation may fail in heavily calcified annuli and adds risk. TAKE-HOME MESSAGES: Severe calcification and commissural misalignment can limit balloon postdilation. Careful computed tomography planning can identify favorable frame-based access (eg, Evolut FX+ diamond cell) and enable effective PVL closure in selected anatomies.
No takes yet. Share an insight, caveat, or question.
Kharsa et al. (2026) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: