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Long-Term Outcomes of Mild Paravalvular Leak Following Transcatheter Aortic Valve Replacement

Akiva Rosenzveig1, Shivabalan Kathavarayan Ramu1, Besir Besir1

  • 1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Structural Heart : the Journal of the Heart Team
|September 2, 2025
PubMed
Abstract

Insights

Mild paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) did not lead to worse clinical outcomes or cardiac remodeling over two years. This finding suggests mild PVL is not a significant long-term concern post-TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Paravalvular leak (PVL) is a common complication following transcatheter aortic valve replacement (TAVR).
  • The long-term clinical impact of mild PVL after TAVR remains a subject of debate.
  • Understanding the consequences of mild PVL is crucial for patient management and procedural optimization.

Purpose of the Study:

  • To evaluate the 2-year clinical and hemodynamic outcomes of patients with mild PVL after TAVR.
  • To compare outcomes between patients with mild PVL and those with no/trace PVL.
  • To determine if mild PVL is associated with adverse events or impaired cardiac remodeling.

Main Methods:

  • Retrospective cohort study of 2601 adult patients undergoing TAVR.
  • Patients were stratified into mild PVL and no/trace PVL groups.
  • Clinical outcomes (mortality, heart failure hospitalization) assessed via Cox regression; hemodynamic changes analyzed using linear mixed models over 2 years.

Main Results:

  • Mild PVL was identified in 5% of patients (140/2601).
  • Patients with mild PVL were older, had lower BMI, and higher rates of left ventricular hypertrophy and mitral regurgitation.
  • No significant difference in 2-year all-cause mortality (HR 1.24) or heart failure hospitalization (HR 1.19) was observed between groups. Hemodynamic parameters remained similar.

Conclusions:

  • Mild PVL following TAVR is not associated with adverse long-term clinical outcomes up to 2 years.
  • Significant impairment in cardiac remodeling was not observed in patients with mild PVL compared to those with no/trace PVL.
  • These findings suggest mild PVL may not require aggressive intervention and has a benign long-term prognosis.
Keywords:
OutcomesParavalvular leakTranscatheter aortic valve replacement

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