Improvement in residual paravalvular leakage after transcatheter aortic valve replacement with a self-expanding valve: ACURATE neo2 versus ACURATE neo

The paravalvular leakage (PVL) incidence immediately after transcatheter aortic valve replacement (TAVR) is reportedly lower with ACURATE neo2 than with ACURATE neo. However, the difference in the subsequent PVL improvement between these valves and the improvement mechanism remain unclear. This study aimed to compare the incidence of and changes in the PVL between these valves and investigate the factors associated with PVL improvement. We included 403 patients who underwent TAVR with ACURATE neo2 (n = 134) or ACURATE neo (n = 269). The study endpoint was PVL improvement, defined as a reduction in the PVL grade from mild or higher at discharge to none/trace at 3 months. The PVL incidence of mild grade or higher was significantly lower with ACURATE neo2 than with ACURATE neo at 3 months (15.7% vs. 25.7%; p = 0.0234) but did not differ significantly at discharge (33.3% vs. 27.5%; p = 0.2291). A significant decrease in the PVL was observed only with ACURATE neo2 (p < 0.0001). Multivariate analysis demonstrated that ACURATE neo2 and calcium volume of the aortic leaflets were independent predictors of PVL improvement. The incidence of mild grade or higher PVL was lower with ACURATE neo2 than with ACURATE neo at 3 months due to the subsequent improvement. Patient selection focusing on leaflet calcification is important for preventing PVL because severe calcification impedes PVL improvement.