Balloon post-dilation after transcatheter aortic valve replacement: a solution worth trying in patients with residual aortic insufficiency.

In daily practice, we are confronted with a dilemma: what to do if we find a relevant paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR): Should we optimize the hemodynamic result by post-dilating the valve prosthesis? Or should we accept the PVL? Are we willing to increase the procedural risk in order to reduce potential long-term sequelae? Balloon post-dilation (PD) is technically simple and effective in many occasions. Therefore, it has been frequently adopted as first-line therapy of PVL to reduce the degree of residual aortic regurgitation (AR). However, there is a scarcity of data to support this strategy, and many issues remain controversial: How relevant is a PVL? What is its real clinical consequence? What is the efficacy of PD? What is the risk of PD?