Aortic regurgitation after transcatheter aortic valve replacement: is it a fall from grace or just a storm in a teacup?

Adecade of great enthusiasm has emerged after the first-in-man, successful transcatheter aortic valve replacement (TAVR) report in 2002. Subsequently, the results of the pivotal randomized Placement of AoRTic TraNscathetER (PARTNER) trial were instrumental for the TAVR approval as the standard of care for symptomatic inoperable aortic stenosis. 1 This 10-year successful history had major drawbacks that were mostly related to the procedure and overcome, in part, by technique and device refinements. Although the short-term outcomes have improved ( 10%), the long-term mortality post-TAVR has not changed over time. 2-5 Moreover, the high incidence and the association of post-TAVR aortic regurgitation with mortality have been raising concerns. 6,7 However important methodological considerations across these studies hamper the understanding of whether this phenomenon represents a “fall from grace” or just a “storm in a teacup”.