Introduction: More than mild paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) represents one of the negative predictive factor for survival and quality of life after TAVI (1). However, quantification and definition of more than mild PVR remains to be unified. Most commonly used 3 stage grading scheme is often insufficient (2). Aim of this research was to assess differences in incidence of more than mild PVR during and after TAVI comparing 3 and 5 grades staging schemes.

Patients and Methods: Study included 40 patients that underwent TAVI between July 2016 and January 2019 in general anesthesia with transesophageal echocardiography (TEE) during procedure. TEE exams had to be sufficiently recorded to quantify PVR with both grading schemes. Parameters used for PVR quantification and differences between models are presented in Table 1.

Results: After initial valve implantation 10 (25%) patients had more than mild PVR when quantified using 3 grade model compared to 19 (47.5%) using 5 grade model (p<0.001). Furthermore, 2 patients with severe PVR assessed by 5 stage model were stratified as having moderate PVR using 3 stage model. In total 14 (35%) patients underwent postdilatation and in 3 (7.5%) of them additional valve was implanted. As final result more than mild PVR was present in 2 (5%) patients using 3 grade model and in 12 (30%) using 5 grade model (p=0.027). Detailed stratification of PVR severity is presented in Table 2.

Conclusion: Utilization of proposed 5 stage grading scheme for evaluation of PRV after TAVI provides more detailed stratification of PVR compared to 3 stage model. The largest difference between models is observed in patients with borderline, mild to moderate PVR. Whether this have implications on patient clinical outcome remains to be determined.