Key result
Successful transcatheter PVR reduction linked to ~63% lower 1-year mortality vs persistent regurgitation.
Why the study?
Paravalvular regurgitation after TAVI is associated with increased morbidity and mortality, but the effect of transcatheter interventions to treat it remained unclear.
Does transcatheter intervention (redo-TAVI, plug closure, or balloon valvuloplasty) improve survival in patients with ≥ moderate paravalvular regurgitation after TAVI?
Cohort (n=201)
Yes
Does transcatheter intervention (redo-TAVI, plug closure, or balloon valvuloplasty) improve survival in patients with ≥ moderate paravalvular regurgitation after TAVI?
Absolute Event Rate: 8% vs 21.4%
p-value: p=0.007
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“PVL manifests through diverse aetiologies, encompassing mal positioning, under-expansion, and uneven calcium distribution. The choice of remedy should align with the specific aetiology. Redo-TAV implantation (TAVI), for instance, holds promise in cases of mal positioning, potentially enhancing annular sealing, whereas balloon valvuloplasty may rectify under-expansion of the TAV.”
Successful transcatheter reduction of late paravalvular regurgitation after TAVI to mild or less is associated with significantly improved 1-year survival.
AIMS: Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated. METHODS AND RESULTS: A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007]. CONCLUSION: This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation.
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Landes et al. (2023) conducted a cohort in Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) (n=201). Successful transcatheter reduction of paravalvular regurgitation (AR ≤ mild) vs. Persistent paravalvular regurgitation (AR ≥ moderate) was evaluated on Mortality at 1 year (p=0.007). Successful transcatheter reduction of paravalvular regurgitation to ≤ mild was associated with significantly lower 1-year mortality compared to persistent ≥ moderate regurgitation (8.0% vs 21.4%, p=0.007).
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