Association Between Changes in Paravalvular Leakage After Transcatheter Aortic Valve Implantation and Serum Lactate Dehydrogenase

Abstract

Background: The association between changes in paravalvular leakage (PVL) and serum lactate dehydrogenase (LDH) levels in patients undergoing transcatheter aortic valve implantation (TAVI) is unexplored. We aimed to investigate the short-term changes in PVL after TAVI and their association with LDH elevation.

Methods: A total of 550 consecutive patients underwent TAVI from 2020 to 2024. Of these, 313 receiving SAPIEN 3 (S3) or SAPIEN 3 Ultra RESILIA (S3UR) valves were included in this study. Patients were categorized into two groups based on whether their PVL severity worsened by at least one grade from immediately after the procedure to hospital discharge.

Results: PVL deterioration was observed in 16.3% of patients. The incidence of moderate or greater LDH elevation was significantly higher in the PVL deterioration group than in the non-PVL deterioration group at 7 days (17.6% vs. 8.4%; P = 0.04) and 1 month (29.4% vs. 8.8%; P < 0.01) after the procedure. The area under the receiver operating characteristic (ROC) curve for predicting PVL deterioration using the sizing index (SI) was 0.84, with an optimal cut-off value of 96.5% (odds ratio (OR): 13.6; 95% confidence interval (CI): 6.55–31.1; P < 0.01). Multivariable analysis showed that an aortic valve calcium score ≥ 1,435, use of the S3UR valve, and an SI < 96.5 were independently associated with PVL deterioration.

Conclusion: Early PVL deterioration after TAVI with a balloon-expandable valve may be associated with LDH elevation. These findings highlight the importance of selecting a prosthetic valve with an appropriate sizing ratio to minimize PVL deterioration after TAVI.