Paravalvular regurgitation after transcatheter aortic valve replacement: Diagnosis, clinical outcome, preventive and therapeutic strategies

Paravalvular regurgitation is a common, potentially life-threatening complication of transcatheter aortic valve replacement. Previous studies report a 65%–94% rate of paravalvular leakage after transcatheter implantation, mostly of mild degree. The rate of significant (≥ + 2) paravalvular regurgitation varies in large clinical trials, and is associated with worse clinical outcome. There is less agreement regarding the significance of mild regurgitation (grade 1 +). There are anatomical and procedural correlates for paravalvular leak—most importantly, severe valve calcification, patient prosthetic mismatch, and device malposition. The following review details the current knowledge on paravalvular regurgitation after transcatheter aortic valve replacement, including diagnosis, correlates, clinical outcome, preventive and therapeutic strategies related to this complication.