Residuelle paravalvuläre Prothesenleckage nach TAVI – prognostisch relevant?

Abstract

The occurrence of paravalvular leakages (PVL) after transcatheter aortic valve implantation (TAVI) is frequent, and more than mild PVL have been associated with increased in-hospital mortality and an unfavorable long-term outcome. The higher incidence of PVL after TAVI than after surgical aortic valve replacement obviously relates to the different procedures. With TAVI, the calcified native leaflets are crushed against the aortic anulus during implantation, possibly preventing adequate stent-frame expansion and thus causing PVL. Possible prosthesis/aortic anulus discongruence due to indirect anulus sizing and limited prosthesis sizes available play also an important role. The TAVI operator is often faced with the problem whether or not PVL should be corrected immediately, e.g. by postdilatation, snaring or valve-in-valve implantation. Recently proposed quantitative evaluation of PVL by use of the aortic regurgitation index (ARI), the transaortic pressure gradient ∆PDAP–LVEDP and the myocardial supply-demand ratio (DPTI/SPTI) can facilitate on-table decision making. Upgraded multi-modality imaging by use of 3D-echocardiography and multi-detector computed tomography but also „balloon-sizing“ in cases with borderline anulus sizes may improve valve size selection and thus reduce PVL. In addition, next-generation devices offer dedicated PVL-solutions. This article gives an overview about the grading of PVL after TAVI, its incidence and prognostic impact and reduction strategies.

• Literatur

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