An common complication following transcatheter aortic replacement is paravalvular regurgitation (PAR). Mild to moderate regurgitation occurs in over 50% of patients. The 1 year mortality of patients after TAVI correlate with the severity of the regurgitation.
Aortic Valve Changes after TAVI
Transcatheter cardiac interventions are a fast evolving field. Aortic valve intervention is usually performed for aortic stenosis. Transcatheter aortic valve implantation (TAVI, TAVR) has shown to improve valve area from 0.7 cm2 to 1.7 cm2. This is associated with an decrease in the gradient from 45 mmHg to 7 mmHg. Not unexpectedly, this often provides substantial symptomatic relief for patients.
TAVI Paravalvular Regurgitation
Regurgitation is caused by deployment problems and anatomic issues.
- Valve size used relative to the anatomy
- Balloon size used for the valvuloplasty
- Depth placement within the valve
- Calcification of the native valve
- Native valve leaflet entrapment
- Dilation of the supravalvular aorta
2-dimensional transthoracic echocardiography (TTE) is convenient for for assessing paravalvular regurgitation, but does not provide adequate quantification and spatial resolution. Transesophageal echocardiography (TEE) overcomes these barriers at the expense of requiring an invasive procedure. Angiographic supravalvular injection and hemodynamic measurements can also provide functional estimates of regurgitation.
The maximum regurgitation tends to occur between the intersection of the noncoronary cusp and along the left coronary coronary cusp.
With hemodynamically significant regurgitation, a postdilation can often significantly reduce paravalvular regurgitation without increased risk of stroke or permanent pacemaker placement.
Regurgitation Changes During 1 Year
Overtime, most the paravalvular regurgitant jets decrease, and some disappear completely. The cross-sectional area of the regurgitation typically decreases about 45% (0.36 cm2 to 0.12 cm2). This is reflected in the decrease of involved perimeter which decrea