Prognostic influence of paravalvular leak following TAVI: is aortic regurgitation an active incremental risk factor or just a mere indicator?

This editorial refers to ‘Paravalvular regurgitation after transcatheter aortic valve replacement with the Edwards sapien valve in the PARTNER trial: characterizing patients and impact on outcomes’[†][1], by S. Kodali et al ., on page 449. Transcatheter aortic valve implantation (TAVI) has become the treatment of choice for inoperable patients with severe aortic stenosis and is a valuable therapeutic option for patients at high risk.1,2 Recent data suggest that TAVI can also be adopted in intermediate risk patients with competitive results when compared with surgery.3 For further expansion of indications, TAVI should, however, be demonstrated to be safe and effective in the longer term, and reduce the rate of complications. Paravalvular leak (PVL) after TAVI is a frequent problem and is considered the Achille's heel of TAVI. A recent meta-analysis including 12 926 TAVI patients reported a pooled estimate incidence of moderate or severe PVL of 11.7%.4 Residual moderate/severe PVL has a relevant negative prognostic impact and has been associated with an increased risk of all-cause mortality.4 More recently, it has been suggested that mild PVR may also be a relevant predictor of mortality, but this association remains controversial.4 This report from Kodali et al .5 represents the largest published single study to evaluate the impact of PVL following TAVI with the Edwards Sapien valve (and one of the largest overall ever reported) on clinical and echocardiographic outcome. In this analysis, the impact of varying degrees of PVL on mortality as well as changes in ventricular function was evaluated in 2434 patients … [1]: #fn-2