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Paravalvular Leak After Transcatheter Aortic Valve Implantation: Results From 3600 Patients

Nav Warraich1, James A Brown1, Eishan Ashwat1

  • 1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.

The Annals of Thoracic Surgery
|February 2, 2025
PubMed
Abstract

Insights

Moderate to severe paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) significantly reduces survival. Mild PVL may lead to a delayed decrease in survival, warranting further investigation.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Prosthetic Heart Valves

Background:

  • Paravalvular leak (PVL) is a known complication of transcatheter aortic valve implantation (TAVI).
  • The long-term survival impact of mild PVL after TAVI remains uncertain.
  • Understanding PVL incidence and progression is crucial for patient outcomes.

Purpose of the Study:

  • To determine the incidence of PVL after TAVI.
  • To evaluate the impact of PVL severity on long-term patient survival.
  • To investigate the progression of PVL over time.

Main Methods:

  • Retrospective cohort study of 3600 patients undergoing TAVI.
  • Patients stratified by 30-day PVL severity: none to trace, mild, and moderate to severe.
  • Multivariable logistic regression and Cox proportional hazards regression used for analysis.

Main Results:

  • Moderate to severe PVL was associated with significantly increased mortality (HR 1.80).
  • Mild PVL did not show a significant association with increased mortality on multivariable analysis (HR 1.01).
  • A trend towards reduced survival in the mild PVL group after 2 years was observed but did not persist.

Conclusions:

  • Moderate to severe PVL after TAVI is linked to reduced survival.
  • Mild PVL may be associated with a delayed reduction in survival.
  • Further research is needed to clarify the long-term implications of mild PVL.

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