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Good enough…isn't

Denise Auberson1, William Gray1

  • 1Lankenau Heart Institute, 100 Lancaster Avenue, Suite 356 MOB East Wynnewood, PA 19096.

Insights

Mild paravalvular regurgitation (PVR) increases mortality after transcatheter aortic valve replacement (TAVR), particularly in high-risk patients. Further research is needed to understand PVR

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Prosthetic Valve Performance

Background:

  • Mild paravalvular regurgitation (PVR) is linked to increased all-cause and cardiovascular mortality post-transcatheter aortic valve replacement (TAVR).
  • This association is particularly pronounced in patients deemed at high surgical risk.
  • Potential explanations include mechanistic factors, associative links, and challenges in accurately assessing PVR.

Discussion:

  • The precise mechanisms driving the increased mortality associated with mild PVR after TAVR require further elucidation.
  • Investigating both direct (mechanistic) and indirect (associative) pathways is crucial.
  • The role of imprecise ascertainment methods in potentially confounding the observed relationship needs consideration.

Key Insights:

  • Mild PVR is a significant predictor of adverse outcomes following TAVR.
  • High-risk surgical patients represent a vulnerable population where PVR's impact is amplified.
  • Current understanding of PVR's etiology and its precise contribution to mortality is incomplete.

Outlook:

  • Upcoming clinical trials employing novel valve technologies and expanded patient cohorts are expected to provide clearer insights.
  • Systematic and standardized assessment of PVR will be vital for future research.
  • These advancements aim to clarify the prevalence, causality, and clinical impact of PVR in TAVR patients.

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