Key result
Post-TAVR paravalvular regurgitation ≥2+ in LFLG-AS linked to ~3.8-fold higher 2-year mortality or HF hospitalization.
Why the study?
Does paravalvular regurgitation ≥2+ increase the risk of all-cause death and heart failure hospitalization in patients with severe low-flow, low-gradient aortic stenosis undergoing TAVR?
Cohort (n=1,358)
Yes
Does paravalvular regurgitation ≥2+ increase the risk of all-cause death and heart failure hospitalization in patients with severe low-flow, low-gradient aortic stenosis undergoing TAVR?
Answers are grounded in this paper and cite their sources.
In patients with low-flow, low-gradient aortic stenosis undergoing TAVR with current-generation devices, mild-to-moderate or worse paravalvular regurgitation (≥2+) at discharge is independently associated with nearly a four-fold increased risk of death or heart failure hospitalization at 2 years across both classical and paradoxical subtypes.
BACKGROUND: Paravalvular regurgitation (PVR) is a frequent complication after transcatheter aortic valve replacement (TAVR) and may influence clinical outcomes in patients with high-gradient aortic stenosis. However, its prognostic relevance in patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing TAVR remains incompletely elucidated. OBJECTIVES: This study sought to evaluate the prognostic significance of PVR severity in patients with LFLG-AS undergoing TAVR with current-generation prostheses. METHODS: This multicenter registry-based cohort study included consecutive patients with LFLG-AS undergoing TAVR from January 2019 to December 2024 at 17 high-volume Italian centers. PVR severity was classified using a 5-class grading scheme and stratified as <2+ (none/trace or mild) or ≥2+ (mild-moderate or worse) based on separation of Kaplan-Meier curves for the primary outcome. The primary outcome was a composite of all-cause death and heart failure hospitalization up to 2 years. Propensity score-weighted Cox regression was used to estimate the independent impact of PVR severity on clinical outcomes. RESULTS: A total of 1,358 patients were included. Kaplan-Meier analysis showed lower event-free survival among patients with ≥2+ PVR at discharge compared with those with <2+ PVR. After propensity score weighting, PVR ≥2+ was independently associated with a higher risk of the primary endpoint (adjusted HR: 3.77; 95% CI: 2.88-4.95), as well as higher risks of all-cause death, mainly cardiovascular, and heart failure hospitalization. These findings were consistent across both classical and paradoxical LFLG-AS phenotypes. CONCLUSIONS: In this large, real-world study of patients with LFLG-AS treated with current-generation TAVR devices, PVR ≥2+ was independently associated with worse clinical outcomes after discharge, regardless of LFLG-AS subtype.
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Bellino et al. (2026) conducted a cohort in Severe low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing TAVR (n=1,358). Paravalvular regurgitation (PVR) ≥2+ (mild-moderate or worse) at discharge vs. Paravalvular regurgitation (PVR) <2+ (none/trace or mild) at discharge was evaluated on Composite of all-cause death and heart failure hospitalization up to 2 years (adjusted HR 3.77, 95% CI 2.88-4.95). Paravalvular regurgitation ≥2+ after TAVR in LFLG-AS increased the 2-year risk of all-cause death or heart failure hospitalization (adjusted HR 3.77; 95% CI 2.88-4.95).
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