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      Leaving obstacles aside: Antegrade paravalvular leakage closure after transcatheter aortic valve replacement

      case-report

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          Abstract

          Paravalvular leakage (PVL) is yet a potential and serious complication after transcatheter aortic valve replacement. Percutaneous PVL closure may be the treatment of choice upon failure of balloon postdilation in patients with excessive surgical risk. If the retrograde approach fails, an antegrade strategy might provide the solution.

          Abstract

          Transcatheter heart valves with large frames pose specific challenges for transcatheter paravalvular leakage closure. When the retrograde approach fails despite the use of high‐support guidewires, an antegrade approach could help overcome this issue based on the diminished interaction with the transcatheter heart valve structures.

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          2021 ESC/EACTS Guidelines for the management of valvular heart disease

          Alec Vahanian, Friedhelm Beyersdorf, Fabien Praz … (2022)
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            Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature.

            Jan-Malte Sinning, Antonio Colombo, Sarah Svensson … (2013)
            This study was designed to establish the incidence, impact, and predictors of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR). AR is an important limitation of TAVR with ill-defined predictors and unclear long-term impact on outcomes. Studies published between 2002 and 2012 with regard to TAVR were identified using an electronic search and reviewed using the random-effects model of DerSimonian and Laird. From 3,871 initial citations, 45 studies reporting on 12,926 patients (CoreValve [Medtronic CV Luxembourg S.a.r.l., Tolochenaz, Switzerland] n = 5,261 and Edwards valve [Edwards Lifesciences, Santa Ana, California] n = 7,279) were included in the analysis of incidence and outcomes of post-TAVR AR. The pooled estimate for moderate or severe AR post-TAVR was 11.7% (95% confidence interval [CI]: 9.6 to 14.1). Moderate or severe AR was more common with use of the CoreValve (16.0% vs. 9.1%, p = 0.005). The presence of moderate or severe AR post-TAVR increased mortality at 30 days (odds ratio: 2.95; 95% CI: 1.73 to 5.02) and 1 year (hazard ratio: 2.27; 95% CI: -1.84 to 2.81). Mild AR was also associated with an increased hazard ratio for mortality, 1.829 (95% CI: 1.005 to 3.329) that was overturned by sensitivity analysis. Twenty-five studies reported on predictors of post-TAVR AR. Implantation depth, valve undersizing, and Agatston calcium score (r = 0.47, p = 0.001) were identified as important predictors. Moderate or severe aortic regurgitation is common after TAVR and an adverse prognostic indicator of short- and long-term survival. Incidence of moderate or severe AR is higher with use of the CoreValve. Mild AR may be associated with increased long-term mortality. Therefore, every effort should be made to minimize AR by a comprehensive pre-procedural planning and meticulous procedural execution. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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              Outcomes 2 Years After Transcatheter Aortic Valve Replacement in Patients at Low Surgical Risk

              Martin Leon, Michael J Mack, Rebecca T. Hahn … (2021)
              In low surgical risk patients with symptomatic severe aortic stenosis, the PARTNER 3 (Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis) trial demonstrated superiority of transcatheter aortic valve replacement (TAVR) versus surgery for the primary endpoint of death, stroke, or re-hospitalization at 1 year.
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                Author and article information

                Contributors
                Alberto Alperi:
                ORCID: https://orcid.org/0000-0002-9939-8949
                alberto.alperi.garcia@hotmail.com
                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (doi): 10.1002/(ISSN)2050-0904
                Journal ID (publisher-id): CCR3
                Title: Clinical Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2050-0904
                Publication date (Electronic): 27 February 2023
                Publication date Collection: February 2023
                Volume: 11
                Issue: 2 ( doiID: 10.1002/ccr3.v11.2 )
                Electronic Location Identifier: e6971
                Affiliations
                [ 1 ] Hospital Universitario Central de Asturias Oviedo Spain
                [ 2 ] Instituto de Investigación Sanitaria del Principado de Asturias, ISPA Oviedo Spain
                [ 3 ] University of Oviedo Oviedo Spain
                Author notes
                [*] [* ] Correspondence

                Alberto Alperi, University Hospital of Asturias, Avenida de Roma s/n, Oviedo, Asturias 33011, Spain.

                Email: alberto.alperi.garcia@ 123456hotmail.com

                Author information
                https://orcid.org/0000-0002-9939-8949
                https://orcid.org/0000-0002-4958-6108
                https://orcid.org/0000-0001-7891-2913
                Article
                Publisher ID: CCR36971 Other ID: CCR3-2023-01-0045
                DOI: 10.1002/ccr3.6971
                PMC ID: 9969761
                PubMed ID: 36860724
                SO-VID: 172c578b-2af9-4455-b57d-211e5c212a60
                Copyright © © 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                Date received : 10 January 2023
                Date accepted : 05 February 2023
                Page count
                Figures: 13, Tables: 0, Pages: 6, Words: 2251
                Categories
                Subject: Case Report
                Subject: Case Report
                Custom metadata
                source-schema-version-number 2.0
                cover-date February 2023
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.5 mode:remove_FC converted:27.02.2023

                Keywords: acute heart failure,aortic valve,paravalvular leak,transcatheter aortic valve replacement,valve replacement
                Data availability:
                Keywords: acute heart failure, aortic valve, paravalvular leak, transcatheter aortic valve replacement, valve replacement

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