Echocardiographic characteristics of paravalvular leak following surgical aortic valve replacement: a retrospective cohort study

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Key findings

• This study identified paravalvular leak (PVL) in 8.1% of surgical aortic valve replacement (SAVR) cases, with the majority of cases being mild in severity.

• PVL was most frequently observed at the mid-portion of the right coronary cusp (RCC). Additionally, significant correlations were identified between PVL locations and calcification sites in the preprocedural aortic valve.

What is known and what is new?

• PVL is a known complication following SAVR. Previous research has primarily focused on its incidence, risk factors, and prognosis; however, few studies have investigated the echocardiographic characteristics of PVL or its relation to the preprocedural aortic valve.

• This study provides new insights into the specific locations and severity of PVL and its association with aortic valve calcification, offering a detailed echocardiographic perspective on PVL following SAVR.

What is the implication, and what should change now?

• The findings suggest that thorough preoperative assessment of calcification sites on the aortic valve may help guide adjustments in surgical approaches to minimize the risk of PVL. Additionally, because PVL severity can evolve postoperatively, clear shared decision-making with patients and close postoperative follow-up are essential.

• Larger multicenter studies are recommended to validate these findings and refine effective clinical strategies for PVL detection and management following SAVR.

Publication: Hayashi Y, Russell JK, Dvorak CJ, Gebska MA, Hanada S, Singhal AK. Echocardiographic characteristics of paravalvular leak following surgical aortic valve replacement: a retrospective cohort study. J Thorac Dis 2025;17(3):1249-1258. doi: 10.21037/jtd-2024-1989