Short-term PVL deterioration after TAVI occurred in 16.3% of patients and was associated with significantly higher hemolysis incidence at 1 month (29.4% vs 8.8%, p<0.01).
Is short-term paravalvular leak deterioration after TAVI associated with increased hemolysis?
Short-term paravalvular leak deterioration after TAVI is associated with increased hemolysis within the first month, highlighting the importance of prosthesis sizing and selection.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment for severe aortic stenosis (AS). However, the incidence of paravalvular leakage (PVL) remains relatively high after TAVI while previous reports have suggested a relationship between postoperative PVL and hemolysis, the direct correlation with short-term PVL changes remains unclear. Purpose This study aimed to clarify the relationship between short-term PVL changes and hemolysis following TAVI. Methods This was a retrospective single-center observational study that included 313 patients who underwent TAVI with balloon-expandable SAPIEN-3/-3 Ultra RESILIA valves between 2020 and 2024. PVL was categorized according to the Valve Academic Research Consortium-3 criteria. The PVL deterioration group was defined as patients whose PVL worsened by at least one grade before discharge compared to immediately after TAVI. Hemolysis was evaluated based on serum lactate dehydrogenase (LDH) levels and classified using the modified Horstkotte criteria. Results The mean age of the patients was 84.3 ± 5.0 years, with a mean Society of Thoracic Surgeons score of 7.4 ± 5.5. PVL deterioration was observed in 16.3% of patients, while 83.7% had no deterioration. LDH levels showed a continuous increase from postoperative day 1 to one month and were significantly higher in the PVL deterioration group. Moderate or greater hemolysis was observed in 6.1% of patients on the first day post-TAVI, increasing to 12.1% at one month. The incidence of moderate or greater hemolysis was significantly higher in the PVL deterioration group at 7 days (17.6% vs. 8.4%, p=0.04) and at one month (29.4% vs. 8.8%, p0.01) compared to the non-PVL deterioration group. The oversizing index was a significant predictor of PVL deterioration, with an ROC-AUC of 0.84 and a cutoff value of 96.5% (OR 13.6, 95% CI 6.55-31.1, p0.01). Multivariate logistic regression identified hypertension (OR 3.99, 95% CI 1.17-13.7, p=0.03), an aortic valve calcium score ≥1435 (median) (OR 6.54, 95% CI 2.62-16.3, p0.01), use of Sapien 3 Ultra RESILIA (OR 4.44, 95% CI 1.19-6.01, p=0.01), and OI 96.5 (OR 10.5, 95% CI 4.45-24.6, p0.01) as independent predictors of PVL deterioration. Conclusion(s) Short-term PVL deterioration following TAVI is associated with an increase in hemolysis, particularly within the first month post-procedure. These findings may emphasize the need for careful prosthesis selection and monitoring strategies to mitigate PVL progression and associated hemolysis in TAVI patients.The degree of hemolysis after TAVI The ROC curve of the oversizing index fo
Ikuta et al. (Sat,) reported a other. Short-term PVL deterioration after TAVI occurred in 16.3% of patients and was associated with significantly higher hemolysis incidence at 1 month (29.4% vs 8.8%, p<0.01).