Clinical Impact of Paravalvular Leaks on Biomarkers and Survival After Transcatheter Aortic Valve Implantation

BackgroundThere is accumulating evidence that up to 20% of the implanted devices after TAVI are associated with a significant degree of paravalvular leaks, which appear to be associated with a negative clinical outcome. MethodsA total of 355 patients with severe aortic valvular stenosis (AVS) were treated by TAVI (Corevalve n=222, Edwards Sapien n=133). Survival, NT-proBNP and the grade of PVL were quantified up to 12 months after implantation. ResultsTechnical success rate was 97.8%. Thirty-day mortality was 9.6%. Post-procedural transvalvular aortic regurgitation was seen only in a minority of cases (5%), whereas PVL were frequently observed (grade: <1+ in 58.2%, 1-<2 in 33.9%, and 2 in 7.9%). There was a clear relation-ship between PVL and adverse outcome (P<0.001). After a transient increase, NT-proBNP showed a significant decline. Interestingly, a PVL 2+ was associated with a much higher rise in NT-proBNP compared to the other groups (P<0.01), and a post-procedural increase in NT-proBNP by more than 1640 ng L-1 within 5 days was associated with a significant increase in rate of death (P<0.01). ConclusionsTAVI is an efficient treatment option for high-risk patients with severe AVS. The incidence of PVL is an inacceptable clinical problem. Serial measurement of NT-proBNP can be used for risk-stratification in patients with a significant PVL. In general, PVL graded 2+ is associated with a dramatically increased 6-month mortality. Therefore, any action to reduce paraprosthetical regurgitation is highly recommended. (c) 2013 Wiley Periodicals, Inc.