Aortic root calcium burden and post-transcatheter aortic valve implantation paravalvular leak: Can’t Live Without It, Can’t Live With It

Transcatheter aortic valve implantation (TAVI) is an established therapeutic option for symptomatic patients with severe aortic stenosis (AS) who are at high risk for surgical aortic valve replacement (SAVR). Evidences from recent trials showed that it may be appropriate to expand the indication of TAVI to patients with intermediate or even low risk of surgery.¹ Compared to SAVR, TAVI is non-inferior in terms of death or disabling stroke rate.² However, because of the sutureless nature of TAVI, despite the fast evolving TAVI technology, many transcatheter heart valves suffer from a greater rate and severity of post-TAVI paravalvular leak (PVL) than the surgical sewing valves.^2,3 Moderate to severe PVL after TAVI has been shown to be an independent risk factor for increased short- and long-term mortality.^4,5 Given the emerging expansion of the TAVI indication to the lower risk population, prevention of post-TAVI PVL becomes even more critical.

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