Prevention and management of paravalvular regurgitation after transcatheter aortic valve implantation.

Abstract

Management of paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI). Most patients with mild PVR can be managed medically with periodic imaging to detect any increase in regurgitant severity. In some patients with moderate to severe or severe PVR, medical therapy may be possible using guideline-directed medical therapy for heart failure or haemolytic anaemia. When intervention is needed, surgical aortic valve replacement (SAVR) may be considered, but many of these patients may be high risk for surgery or prefer to avoid surgical intervention. Transcatheter options include a vascular occluder device, a redo TAVI with placement of a second transcatheter valve (TAV-in-TAV), or balloon dilation of the initial TAVI valve.