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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.
Abstract:
Mild PVR has been shown to increase all-cause and cardiovascular mortality after TAVR, especially in high surgical risk patients. Mechanistic and associative causes, as well imprecise ascertainment have been suggested as underlying etiologies of this association. Ongoing trials with newer valve technologies, broader patient inclusion and more systematic assessment of PVR may provide further insight into the prevalence, causality, and outcome of PVR.
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.