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

Abstract

Background

Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. Mild PVL remains prevalent after TAVI, and its impact on long-term survival is unclear. This study aimed to examine the incidence, impact on survival, and progression of PVL.

Methods

This was a retrospective, single-institution cohort study of TAVIs between November 2012 and January 2023. Patients were stratified by 30-day PVL severity: none to trace, mild, and moderate to severe. Multivariable logistic regression was performed to identify risk factors associated with increasing PVL severity. Kaplan-Meier survival estimation and Cox proportional hazards regression were performed.

Results

A total of 3600 patients underwent TAVI. Of these, 2719 (75.5%) had none to trace PVL, 808 (22.5%) had mild PVL, and 73 (2.0%) had moderate to severe PVL at 30 days. On multivariable logistic regression, later years of valve implantation (2017-2023) were protective against PVL progression. Kaplan-Meier estimates of the 3 groups were significantly different (P < .001) with the moderate to severe group having reduced survival. On Cox regression, moderate to severe PVL was associated with increased mortality (hazard ratio, 1.80; 95% Cl, 1.31-2.46; P < .001), whereas mild PVL was not (hazard ratio, 1.01; 95% CI, 0.89-1.15; P = .88) compared with none to trace PVL. For Kaplan-Meier estimates comparing the none to trace and mild PVL groups alone, landmark analysis showed reduced survival in the mild PVL group after 2 years (P = .03); however, this late reduction in survival in the mild PVL group did not persist on multivariable analysis (P = .14).

Conclusions

After TAVI, moderate to severe PVL is associated with reduced survival compared with none to trace PVL. Mild PVL may result in a delayed survival reduction.