November 14, 2022Open Access

Impact of Paravalvular Leak on Outcomes After Transcatheter Aortic Valve Implantation: Meta-Analysis of Kaplan-Meier-derived Individual Patient Data

Structured PICO

Does paravalvular leak increase the risk of mortality and rehospitalization in patients after TAVI?

Population

Patients after transcatheter aortic valve implantation (TAVI)

Intervention

Presence of paravalvular leak (PVL), including mild PVL

Comparator

Absence of PVL or lesser severity of PVL

Outcome

All-cause mortality/survival, rehospitalization, and/or cardiovascular mortalityhard clinical

Even mild paravalvular leak after TAVI is associated with a significantly higher risk of all-cause mortality, cardiovascular mortality, and rehospitalization.

Abstract

Background: Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is frequent and the impact of mild PVL on outcomes remains uncertain. Our study aimed to evaluate the impact of PVL on TAVI outcomes. Methods: To analyze late outcomes of patients after TAVI according to the presence and severity of PVL, PubMed/MEDLINE, EMBASE and Google Scholar were searched for studies that reported rates of all-cause mortality/survival and/or rehospitalization and/or cardiovascular mortality accompanied by at least one Kaplan-Meier curve for any of these outcomes. We adopted a 2-stage approach to reconstruct individual patient data based on the published Kaplan-Meier graphs. Results: < 0.001) during follow-up. Conclusions: Patients with PVL, even if mild, experience higher risk of all-cause mortality, rehospitalization, and cardiovascular mortality following TAVI. These findings provide support to the implementation of procedural strategies to prevent any degree of PVL at the time of TAVI.

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