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

Abstract

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. 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. 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). 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.