The retro-antegrade approach to paravalvular leak closure after transcatheter aortic valve replacement

Figure 1. Fluoroscopic images illustrating three “retro-antegrade” cases of post-TAVR PVL closure (*=calcium).

Paravalvular leak (PVL) post transcatheter aortic valve replacement (TAVR) is challenging to close due to the presence of the transcatheter valve frame and calcium along the leak. We adopted the “retro-antegrade” approach to facilitate catheter and device delivery in closing three SAPIEN 3 (Edwards Lifesciences, Irvine, CA, USA) PVLs 3 months, 5 months and 1 month post TAVR, respectively, due to bulky left ventricular outflow tract (LVOT) calcium. Single arterial access for a 14 Fr DrySeal sheath (W. L. Gore & Associates, Inc., Flagstaff, AZ, USA) ...