Dear Colleagues,

Paravalvular leak (PVL) is a common complication associated with surgical valve replacement and more recently transcatheter valve implantation procedures. Approximately 1% to 5% of patients undergoing mitral or aortic valve replacement experience PVL of various severities, ranging from asymptomatic to life-threatening such as hemolysis, heart failure, and increased risk of endocarditis. Similarly, significant paravalvular aortic regurgitation after transcatheter aortic valve implantation (TAVI) is associated with poor short- and long-term prognosis and underlines the importance of the assessment and treatment of post-TAVI PVL.

Early recognition and intervention are imperative for appropriate management, as medical therapy is not effective. Available imaging techniques such as different echocardiographic modalities, multidimensional computed tomography, and cardiac nuclear resonance in defining the complex anatomy, position, size of the leakage and its quantification are essential for pre-procedural planning. Defect location and shape can present challenges to crossing the leak. Pre-procedure planning for access route is useful to improve procedure success and further optimize outcomes. In particular, intraprocedural fusion of real-time three-dimensional transesophageal echocardiography and cardiac fluoroscopy imaging on the same display have undoubtedly improved the navigation, safety, and efficacy of this technically challenging procedure.

A repeated surgical procedure is generally related to high perioperative risk. For the high-risk symptomatic PVL patient, catheter-based closure conversely has significantly less morbidity and represents a viable therapeutic alternative, with a high success and low complication rate.

The results of systematic review and meta-analysis suggest that successful trans-catheter PVL reduction is associated with a decrease in cardiac mortality and functional class improvement in patients unsuitable for surgical correction.

A surprising number of different devices, vascular plugs, and more recently newly dedicated devices have been used to close aortic or mitral paravalvular leaks. Nevertheless, transcatheter interventions have followed a difficult path of development. The difficulties have been mostly linked to technical issues, such as visualization of the defect and suboptimal delivery systems.

The Special Issue will summarize the most relevant data on the clinical, diagnostic, and technical aspects of PVL treatment and will point out to its limitations and future development.

We hope that this Special Issue “Latest Advances in Paravalvular Leak” will contribute to an increase in the understanding of the problem and will foster international collaboration on the development in this area.

Prof. Dr. Eustaquio Maria Onorato
Prof. Dr. Grzegorz Smolka
Prof. Dr. Wojtek Wojakowski
Guest Editors

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• Percutaneous interventions
• Paravalvular leak
• Echocardiography
• Fusion imaging modalities
• Intraprocedural guidance
• Paravalvular leak closure technique