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van Wely, M, Rooijakkers, M, Stens, N, El Messaoudi, S, Somers, T, van Garsse, L, Thijssen, D, Nijveldt, R and van Royen, N (2024) Paravalvular regurgitation after transcatheter aortic valve replacement: incidence, quantification, and prognostic impact. European Heart Journal. Imaging Methods and Practice, 2 (2). ISSN 2755-9637
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Paravalvular regurgitation after transcatheter aortic valve replacement incidence, quantification, and prognostic impact.pdf - Published Version Available under License Creative Commons Attribution Non-commercial. Download (921kB) | Preview |
Abstract
Transcatheter aortic valve replacement (TAVR) is the standard of care in aortic stenosis with results comparable to surgical aortic valve replacement. However, paravalvular regurgitation (PVR) is more common after TAVR. With the alteration of devices and implantation techniques, the incidence of moderate or more PVR has declined. Mild PVR is still common in around 30% of TAVR patients in low-risk trials. Progression of AS causes myocardial hypertrophy and varying degrees of diastolic dysfunction which may cause heart failure even in combination with small volumes of PVR. Any degree of PVR is associated with an increased risk of overall and cardiovascular mortality. Predictors of PVR are annular eccentricity, severe calcification of the aortic valve, bicuspid aortic valves, and type of prosthesis where balloon-expandable devices are associated with less PVR. PVR is diagnosed using echocardiography, aortic angiogram with or without videodensitometry, haemodynamic parameters, or cardiac magnetic resonance. PVR can be treated using post-dilation, interventional treatment using a vascular plug, or implantation of a second device. Successful post-dilation depends on balloon size which should at least be equal to or >95% of the mean annulus diameter. Implantation of a second device to reduce PVR is successful in ∼90% of cases, either through lengthening of the sealing skirt in case of inadequate position or through further expansion of the index device. Implantation of a vascular plug can successfully reduce PVR and reduce mortality.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | aortic stenosis; paravalvular regurgitation; transcatheter aortic valve replacement |
| Subjects: | R Medicine > RC Internal medicine |
| Divisions: | Sport and Exercise Sciences |
| Publisher: | Oxford University Press (OUP) on behalf of the European Society of Cardiology |
| SWORD Depositor: | A Symplectic |
| Date Deposited: | 18 Oct 2024 09:24 |
| Last Modified: | 18 Oct 2024 09:30 |
| DOI or ID number: | 10.1093/ehjimp/qyae040 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/24549 |
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