TY - JOUR JO - EuroIntervention TI - Five-year outcomes of mild paravalvular regurgitation after transcatheter aortic valve implantation AB - <p><strong>Background:</strong> Mild paravalvular regurgitation (PVR) remains a frequent and underappreciated adverse event after transcatheter aortic valve implantation (TAVI) despite remarkable progress in device technology and implantation technique.</p> <p><strong>Aims:</strong> This study sought to investigate the impact of mild PVR after TAVI on five-year clinical outcomes.</p> <p><strong>Methods:</strong> In a prospective TAVI registry, PVR prior to discharge was retrospectively assessed in an echocardiographic core laboratory. Patients with &ge;moderate PVR were excluded. Mild PVR was categorised into mild and mild-to-moderate PVR using a recently proposed unifying 5-class grading scheme.</p> <p><strong>Results:</strong> A total of 1,128 patients undergoing TAVI between 2007 and 2015 were enrolled. Of these, 560 patients had mild PVR, including 433 with mild (5-class) PVR and 127 with mild-to-moderate PVR. Patients with mild PVR were older (83 years vs 82 years, p=0.013) and had a higher surgical risk compared to patients with none/trace PVR (STS-PROM: 6.49&plusmn;4.68 vs 5.41&plusmn;3.48, p&lt;0.001). At five years, patients with mild PVR had a higher risk of mortality than those with none/trace PVR (54.6% vs 43.8%; HR<sub>adjusted</sub> 1.26, 95% CI: 1.06-1.50). When applying the 5-class grading scheme, only mild-to-moderate PVR was associated with an increased risk of mortality at five years (mild PVR: HR<sub>adjusted</sub> 1.19, 95% CI: 0.99-1.43, mild-to-moderate PVR: HR<sub>adjusted</sub> 1.56, 95% CI: 1.20-2.02). The effect of mild PVR on five-year mortality was consistent across major subgroups.</p> <p><strong>Conclusions:</strong> Mild PVR was associated with an increased risk of mortality at five years after TAVI. The detrimental effect was primarily driven by mild-to-moderate PVR using the 5-class grading scheme. Clinical Trial Registration: https://www.clinicaltrials.gov. NCT01368250.</p> AU - Okuno Taishi AU - Tomii Daijiro AU - Heg Dik AU - Lanz Jonas AU - Praz Fabien AU - Stortecky Stefan AU - Reineke David AU - Windecker Stephan AU - Pilgrim Thomas VL - 18 IS - 1 Y1 - 15/05/2022 Y1 - 2022 DOI - 10.4244/EIJ-D-21-00784 SP - 33 EP - 42 KW - aortic stenosis KW - paravalvular leak KW - tavi PB - Europa Digital & Publishing SE - Interventions for valvular disease and heart failure UR - https://eurointervention.pcronline.com/article/five-year-outcomes-of-mild-paravalvular-regurgitation-after-transcatheter-aortic-valve-implantation SN - 1774-024X ER -