Key result
Paravalvular leakage deterioration after TAVI was associated with a higher incidence of moderate or greater LDH elevation at 1 month compared to non-deterioration (29.4% vs 8.8%; P<0.01).
Why the study?
The association between short-term changes in paravalvular leakage and serum lactate dehydrogenase levels in patients undergoing TAVI was unexplored.
Is short-term deterioration in paravalvular leakage after balloon-expandable TAVI associated with elevated serum lactate dehydrogenase levels in patients with severe aortic stenosis?
Observational (n=313)
No
Is short-term deterioration in paravalvular leakage after balloon-expandable TAVI associated with elevated serum lactate dehydrogenase levels in patients with severe aortic stenosis?
Absolute Event Rate: 29.4% vs 8.8%
p-value: p=<0.01
Short-term worsening of paravalvular leakage between TAVI deployment and discharge occurs in 16.3% of balloon-expandable valve recipients—predicted by a sizing index <96.5%, high calcium score, and SAPIEN 3 Ultra RESILIA use—and is independently associated with elevated serum LDH levels at 1 month, highlighting the need for appropriate valve sizing to prevent subclinical or clinical hemolysis.
Background: The association between changes in paravalvular leakage (PVL) and serum lactate dehydrogenase (LDH) levels in patients undergoing transcatheter aortic valve implantation (TAVI) is unexplored. We aimed to investigate the short-term changes in PVL after TAVI and their association with LDH elevation. Methods: A total of 550 consecutive patients underwent TAVI from 2020 to 2024. Of these, 313 receiving SAPIEN 3 (S3) or SAPIEN 3 Ultra RESILIA (S3UR) valves were included in this study. Patients were categorized into two groups based on whether their PVL severity worsened by at least one grade from immediately after the procedure to hospital discharge. Results: PVL deterioration was observed in 16.3% of patients. The incidence of moderate or greater LDH elevation was significantly higher in the PVL deterioration group than in the non-PVL deterioration group at 7 days (17.6% vs. 8.4%; P = 0.04) and 1 month (29.4% vs. 8.8%; P < 0.01) after the procedure. The area under the receiver operating characteristic (ROC) curve for predicting PVL deterioration using the sizing index (SI) was 0.84, with an optimal cut-off value of 96.5% (odds ratio (OR): 13.6; 95% confidence interval (CI): 6.55–31.1; P < 0.01). Multivariable analysis showed that an aortic valve calcium score ≥ 1,435, use of the S3UR valve, and an SI < 96.5 were independently associated with PVL deterioration. Conclusion: Early PVL deterioration after TAVI with a balloon-expandable valve may be associated with LDH elevation. These findings highlight the importance of selecting a prosthetic valve with an appropriate sizing ratio to minimize PVL deterioration after TAVI.
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Ikuta et al. (2026) conducted an observational in Severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=313). Paravalvular leakage (PVL) deterioration (worsening by ≥1 grade from immediately post-procedure to hospital discharge) vs. Non-PVL deterioration was evaluated on Moderate or greater serum lactate dehydrogenase (LDH) elevation at 1 month after TAVI (p=<0.01). Paravalvular leakage deterioration after TAVI was associated with a higher incidence of moderate or greater LDH elevation at 1 month compared to non-deterioration (29.4% vs 8.8%; P<0.01).
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