Key result
Increasing paravalvular leak after TAVR is linked to higher stroke risk, reaching ~15% at five years.
Why the study?
While PVL is associated with increased mortality after TAVR, its relationship with long-term cerebrovascular events remains incompletely characterized.
Does PLVAD reduce early all-cause mortality compared to IABP in patients undergoing high-risk PCI without cardiogenic shock?
Meta-Analysis (n=50,000)
Does PLVAD reduce early all-cause mortality compared to IABP in patients undergoing high-risk PCI without cardiogenic shock?
Answers are grounded in this paper and cite their sources.
In patients undergoing high-risk PCI without cardiogenic shock, PLVAD support is associated with lower early mortality, cardiogenic shock, and AKI compared to IABP, with no increase in bleeding or vascular complications.
Background: Paravalvular leak (PVL) remains a common complication following transcatheter aortic valve replacement (TAVR) and reflects suboptimal valve sealing and procedural complexity.While PVL has been associated with increased mortality, its relationship with longterm cerebrovascular events remains incompletely characterized.We performed a systematic review and meta-analysis to evaluate stroke incidence following TAVR across PVL severity grades Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines.PubMed, Embase, Scopus, and Cochrane Library databases were searched through 2024 for studies reporting stroke incidence post-TAVR in patients with documented PVL.A total of 15 studies (n > 50,000) were included.Data were pooled using a random-effects model, and heterogeneity was assessed using the I 2 statistic.Stroke incidence was stratified by PVL severity and follow-up time points (1-year and 5-year); 30-day stroke data were inconsistently reported and excluded from quantitative synthesis.Sensitivity and publication bias analyses were also performed.Results: At 1 year, pooled stroke incidence increased in a graded fashion with PVL severity: 4.2% for mild PVL, 5.8% for moderate PVL, and 7.9% for severe PVL.At 5 years, stroke incidence further increased to 9.1%, 11.6%, and 14.8%, respectively.A consistent dose-response relationship was observed across severity strata and time horizons.Substantial heterogeneity was present among included studies.Sensitivity analyses excluding severe PVL demonstrated modest reductions in pooled stroke incidence at both 1 year (5.17% to 4.72%) and 5 years (10.91% to 10.03%) Conclusions: Increasing PVL severity following TAVR is associated with a progressive increase in observed long-term stroke incidence.Although statistical significance was limited by heterogeneity, the consistent dose-response trend highlights PVL as a clinically meaningful marker of cerebrovascular risk.These findings emphasize the importance of meticulous valve sizing, deployment technique, and post-procedural PVL mitigation strategies to optimize long-term neurological outcomes following TAVR.
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Abdelrahman et al. (2026) conducted a meta-analysis in Paravalvular leak following transcatheter aortic valve replacement (TAVR) (n=50,000). Paravalvular leak (PVL) severity vs. Different severity grades (mild, moderate, severe) was evaluated on Stroke incidence. Increasing paravalvular leak severity following TAVR was associated with a progressive increase in stroke incidence at 1 year and 5 years.
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