**6.1 Specific considerations for post-transcatheter aortic valve replacement paravalvular leaks**

PVL after TAVR increases late mortality [28]. The assessment relies on a multimodality approach (ultrasounds, MSCT, hemodynamic, and angiography). The closure of TAVR-related PVLs can be considered during the TAVR procedure or subsequent follow-up. During the procedure, many techniques are available to reduce regurgitation. Oversized balloon post dilatation is effective to optimize the valve expansion and ensure a better seal but exposes to an over risk of cerebral embolic events. Snares are used when there is an inadequate depth of implantation. It is to consider with caution when there is heavy calcification as it can result also in their detachment and embolization. Valve-in-valve is used when the previous techniques are not feasible, especially when there is a nonoptimal first valve procedure. This technique can also be used later for surgical or transcatheter degenerated valves [29]. TAVR-related PVL can also be reduced by a TPVL as previously described.
