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Paravalvular Leak After TAVI — EECC MCQ

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ModerateValvular Heart DiseaseParavalvular Leak After TAVIEECC

A 55-year-old man with severe aortic stenosis and a heavily calcified bicuspid aortic valve undergoes TAVI. Post-deployment, the aortogram shows moderate paravalvular aortic regurgitation (PVR). What is the most likely cause and management?

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Correct answer: A — Incomplete prosthesis apposition against the calcified native annulus; post-dilation with a larger balloon should be performed to reduce the paravalvular leak

Paravalvular regurgitation (PVR) is the most common form of AR after TAVI, caused by incomplete seal between the prosthesis and the irregularly calcified native annulus. More-than-mild PVR is associated with increased mortality. Management includes: (1) post-dilation (inflating the delivery balloon to higher pressure to improve apposition); (2) valve-in-valve deployment if post-dilation fails; (3) pre-procedural CT annulus sizing and calcium distribution assessment to select optimal valve size. Self-expanding valves (e.g. Evolut) may have slightly higher PVR rates than balloon-expandable (e.g. SAPIEN) due to lower radial force, though newer-generation devices have reduced this difference. Moderate-severe PVR should not be accepted.

Reference: ESC/EACTS (2025): VHD Guidelines