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Updated: Oct 21, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Paravalvular regurgitation after transcatheter aortic valve replacement in intermediate-risk patients: a pooled
Katherine H Chau1,2, Shmuel Chen1,2, Aaron Crowley1
1Cardiovascular Research Foundation, New York, NY, USA.
Background:
Moderate or worse paravalvular regurgitation (PVR) post transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The mechanisms by which this occurs are not fully understood.
Aims:
The aim of this study was to determine the mechanism by which PVR leads to worse outcomes.
Methods:
A total of 1,974 intermediate-risk patients who received TAVR in the PARTNER 2 trial and registries were grouped by PVR severity. Clinical and echocardiographic outcomes were compared.
Results:
Overall 1,176 (60%) patients had none/trace, 680 (34%) had mild, and 118 (6%) had ≥moderate PVR. At two years, ≥moderate PVR patients had increased risks of all-cause (HR 2.33 [1.41-3.85], p-value=0.001) and cardiovascular death (HR 3.30 [1.74-6.28], p-value <0.001), rehospitalisation (HR 2.68 [1.57-4.58], p-value <0.001), and reintervention (HR 14.72 [3.13-69.32], p-value <0.001). Moderate or worse PVR was associated with larger increases in left ventricular (LV) end-diastolic and systolic dimensions and volumes, LV mass indices, and reductions in LV ejection fractions (LVEFs) from 30 days to two years. Mild PVR was not associated with worse outcomes. Adjusting for LV dimensions and LVEF from the one-year echocardiogram, patients with ≥moderate PVR still had an increased risk of all-cause death or rehospitalisation at two years (HR 2.84 [1.25-5.78], p-value=0.009).
Conclusions:
Moderate or worse PVR, but not mild PVR, is associated with an increased risk of all-cause and cardiovascular death, rehospitalisation, and reintervention at two years. Moderate or worse PVR is also associated with adverse LV remodelling, which partially mediates how ≥moderate PVR leads to worse outcomes. These results provide dual insights on the deleterious impact of ≥moderate PVR and the contributing mechanisms of poor clinical outcomes.
Insights
Moderate or worse paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR) increases mortality and adverse left ventricular (LV) remodeling. Mild PVR does not worsen outcomes, but significant PVR requires further investigation for improved patient results.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Moderate or worse paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) is linked to increased mortality.
- The precise mechanisms underlying this association remain incompletely understood.
Purpose of the Study:
- To elucidate the mechanisms by which PVR influences patient outcomes after TAVR.
- To differentiate the impact of mild versus moderate/severe PVR on clinical endpoints and cardiac remodeling.
Main Methods:
- Analysis of 1,974 intermediate-risk patients undergoing TAVR from the PARTNER 2 trial and registries.
- Patients were stratified based on PVR severity: none/trace, mild, and moderate/worse.
- Comparison of clinical and echocardiographic outcomes between PVR groups at two years.
Main Results:
- Patients with moderate or worse PVR (6% of cohort) exhibited significantly higher risks of all-cause death, cardiovascular death, rehospitalization, and reintervention at two years.
- Moderate or worse PVR was associated with adverse left ventricular (LV) remodeling, including increased LV dimensions, volumes, mass, and reduced ejection fraction.
- Mild PVR was not associated with adverse clinical outcomes or LV remodeling.
Conclusions:
- Moderate or worse PVR, but not mild PVR, is a significant predictor of adverse clinical outcomes post-TAVR.
- Adverse LV remodeling partially mediates the negative impact of moderate or worse PVR on patient prognosis.
- These findings highlight the detrimental effects of significant PVR and offer insights into the mechanisms driving poor outcomes.
