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Aortic insufficiency (AI) is common after transcatheter aortic valve replacement (TAVR). It has been linked to mortality that has limited the expansion of this promising technique. Inappropriate valve sizing relative to the native annulus, calcification in the aortic annulus and imprecise implantation (too low relative to the annulus) are the most common causes for post-TAVR AI. A thorough understanding of these factors may therefore allow overcoming this complication. In this review, we describe the prediction and reduction of these factors to minimize post-TAVR AI.

Despite its short length, the left main coronary artery remains one of the most challenging areas of disease in interventional cardiology today. This challenge draws from the need for an accurate diagnosis as well as a changing management strategy. Since the consequences are significant, the use of intravascular ultrasound or fractional flow reserve should be considered when making the diagnosis, especially in cases of intermediate disease. Noninvasive imaging modalities such as cardiac computed tomography have high sensitivity and specificity for the left main coronary artery and will likely have an increasing surveillance role in the future, especially in ruling out disease. Although coronary artery bypass grafting remains the standard of care for the revascularization of this area, advances in interventional cardiology have improved outcomes in selected patients so that they are now comparable to coronary artery bypass grafting at least up to medium-term follow-up. Going forward the preferred revascula...