Paravalvular Leak After Transcatheter Aortic Valve Implantation (TAVI): Comparative Outcomes of Percutaneous Closure Techniques Versus Conservative Management – A Systematic Review

Background: Paravalvular leak (PVL) remains a significant complication following transcatheter aortic valve implantation (TAVI), associated with increased morbidity and mortality. The optimal management strategy—percutaneous closure versus conservative medical therapy—remains debated. Objectives: This study aims to compare the clinical outcomes, hemodynamic efficacy, and long-term survival rates between percutaneous device closure and conservative management in patients with post-TAVI PVL. Methods: A systematic review and meta-analysis were conducted, including randomized controlled trials (RCTs), cohort studies, and case series from major databases (PubMed, Embase, Cochrane Library). Primary endpoints included procedural success, all-cause mortality, heart failure rehospitalization, and echocardiographic parameters of regurgitation severity. Results: Percutaneous closure demonstrated superior reduction in PVL severity (OR 2.45, 95% CI 1.78–3.38, p < 0.001) and improved NYHA functional class compared to conservative management. However, procedural complications (e.g., device embolization, vascular injury) were non-negligible. Conservative therapy showed lower early morbidity but higher long-term heart failure recurrence. Conclusions: Percutaneous closure techniques offer significant hemodynamic benefits in eligible patients, while conservative management may be reserved for high-risk cases. Individualized patient assessment is crucial in determining the optimal therapeutic approach.