Key Points
• Source: Journal of Personalized Medicine
• Conclusions/Relevance: “We present the case report of an 81-year-old patient admitted to our hospital because of exacerbation of the clinical condition and development of pulmonary edema a few days after TAVI. Despite the reduction of the initial leak, an echocardiographic examination revealed the remaining severe paravalvular aortic leakage. We performed open-heart cardio-thoracic surgery, explanted the TAVI valve, and implanted the biological prosthesis (Edwards Perimount Magna size 25). Introduction of new interventional treatment approaches and the availability of imaging tools have substantially reduced the incidence of significant paravalvular leak and offered a better prognosis for patients undergoing TAVI.”
• Transcatheter aortic valve implantation (TAVI) is popular among high-risk patients with severe aortic valve stenosis. Paravalvular leak (PVL) is frequent post-TAVI and reduces short- and long-term survival.
• Mild PVL or worse following TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity. Calcification volume independently predicts PVL. The improper depth of an implanted valve predicts PVL.
• Until recently, it was impossible to change the position of the prosthesis before the final release when the effect of the implanted valve was suboptimal. Consequently, it is necessary to image with transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), multirow-detector computed tomography (MDCT), aortography, or magnetic resonance.
• “The relatively high position of the TAVI scaffold poses a risk of the lack of space left for a cannula or clamp on the ascending aorta. Hence, sometimes it is preferable to cannulate the aorta from underneath the aortic valve via femoral artery cannulation,” the authors concluded.