Am J Cardiovasc Dis 2011;1(3):312-320

Review Article
Valvular leak after transcatheter aortic valve implantation: a clinician update
on epidemiology, pathophysiology and clinical implications

Giuseppe Tarantini, Valeria Gasparetto, Massimo Napodano, Chiara Fraccaro, Gino Gerosa, Giambattista Isabella

Cardiology Division and Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences. University of Padua
Medical School, Padua, Italy.

Received July 29, 2011; accepted August 30, 2011; Epub September 10, 2011; published September 30, 2011

Abstract: During trascatheter aortic valve implantation (TAVI) the native valve is not removed but crushed. Thus, a slight
prosthesis insufficiency is not uncommon and has been reported in about 70% of patients for both available types of
percutaneous valves. However, the definition of clinically “significant” valve regurgitation is not fully established yet. In most
cases, aortic insufficiency is mild and clinical acceptable, however, severe insufficiency can occur. Paravalvular
insufficiency is usually prevalent, and it may be the consequence of prosthesis/patient mismatch due to an undersizing of
the implanted device or to an incomplete expansion of the prosthesis stent frame, or also to incorrect site of prosthesis
implantation. Thus, an accurate assessment of the aortic valve annulus before TAVI  is mandatory in order to select the
optimal size of the valve. The presence of large calcium burden or bicuspid valve as well as the correct implantation of the
device are other key determinants of final valve insufficiency. When severe regurgitation is present, an integration of
hemodynamic, angiographic, transthoracic and TEE data is necessary to tailor the best clinical decision on a per-patient
basis. (AJCD1107007).

Keywords: Valvular leak, transcatheter aortic valve implantation

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Address all correspondence to:
Giuseppe Tarantini, MD, PhD
Division of Cardiology, Department of  Cardiac
Thoracic and Vascular Sciences
Policlinico Universitario
Via Giustiniani, 2, 35128 Padova, Italy.
Tel: +39 049 8211844; Fax: +39 049 8761764
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