Long-Term Outcomes of Mild Paravalvular Leak Following Transcatheter Aortic Valve Replacement.

Background: Paravalvular leak (PVL) remains a frequent complication of transcatheter aortic valve replacement (TAVR). The long-term consequences of mild PVL on outcomes have been debated. This study aimed to investigate the clinical and hemodynamic outcomes of mild PVL over a 2-year period. Methods: We conducted a retrospective cohort study of 2601 adult patients who underwent TAVR at the Cleveland Clinic between January 2016 and July 2021. Patients were categorized based on postprocedural PVL severity (mild vs. no/trace PVL). Differences in 2-year clinical outcomes, including all-cause mortality and heart failure hospitalizations, were assessed using Cox regression analysis, while hemodynamic changes were analyzed with a linear mixed model. Results: Mild PVL was present in 140 patients (5%). Compared to those with no/trace PVL, these patients were older, had a lower body mass index, higher prevalence of concentric left ventricular hypertrophy, and more frequent significant mitral regurgitation. Hemodynamic parameters, including transvalvular aortic mean gradient, left ventricular ejection fraction, and ventricular dimensions, remained similar between groups at 30 days, 1 year, and 2 years. Multivariate Cox regression showed no significant association between mild PVL and 2-year all-cause mortality (hazard ratio: 1.24, 95% CI: 0.65 to 2.39, Conclusions: Mild PVL after TAVR is not associated with adverse long-term clinical outcomes or significant impairment in cardiac remodeling within the first 2 years postprocedure compared to no/trace PVL.