Occurrence and severity of paravalvular leak (PVL) in elderly patients undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR)

Background: TAVI is a rapidly evolving technology that has been shown to be a valuable alternative to SAVR in elderly patients. However, despite the progress made, there remain several potential TAVI limitations that need not to be minimized before implementing this approach. The current analysis aimed to examine the major outcomes of elderly patients treated with TAVI or SAVR focusing on PVL occurrence. Methods: We conducted a retrospective observational study of elderly patients (> 70 years) undergoing isolated TAVI or SAVR between January 2019 and December 2023 at our Institution. The incidence of PVL was the primary endpoint. 30-day mortality and in-hospital length of stay (HLOS) were the secondary outcomes. Results: 271 patients were enrolled (mean age: 79 ± 5 years); the TAVI group included 140 subjects (mean age: 82 ± 4 years), whereas the SAVR group 131 patients (mean age: 82 ± 4 years). The EuroSCORE II was higher in the TAVI group than in the SAVR population (5.1% vs 2.7%, p<0.001). PVL occurrence (of any degree) was significantly lower after SAVR than after TAVI (15.3% vs 78.6%, p<0.001). The majority of PVL were mild in severity (75% and 71% respectively). 30-day mortality rate was numerically lower in the SAVR group than in TAVI (0.8% vs 3.6%, p=0.252). HLOS was comparable between the two groups (8.5 days for SAVR vs 8.2 days for TAVI). Conclusions: TAVI was associated with a higher occurrence of PVL compared with SAVR. Moderate PVL was also more prevalent among the TAVI group.