There is accumulating evidence that up to 20 % of the implanted devices after TAVI are associated with a significant degree of paravalvular leaks (PVL), but the clinical impact of PVL is still insufficiently explored.

A total of 355 patients with severe aortic valvulare stenosis (AVS) were treated by TAVI (Corevalve n = 222, Edwards Sapien n = 133). Survival, NT-pro-BNP and the grade of PVL were quantified up to 12 months after implantation.

Technical success rate was 97 %. Thirty-day mortality was 9.6%. Post-procedural transvalvular aortic regurgitation was seen only in a minority of cases (5%), whereas PVL were frequently observed (grade: <1+ in 58.2%, ≥1+ − <2+ in 33.9%, and ≥2+ in 7.9%). There was a clear relation-ship between PVL and adverse outcome (p <0.001). After a transient increase NT-pro-BNP showed a significant decline. Interestingly, a PVL ≥2+ was associated with a much higher rise in NT-pro-BNP compared to the other groups (p <0.01), and a post-procedural increase in NT-pro-BNP by more than 1640ng/L was associated with a significant increase in rate of death (p <0.01).

TAVI is an efficient treatment option for high-risk patients with severe AVS. The incidence of PVL is an inacceptable clinical problem and still insufficiently recognized. Serial measurement of NT-pro-BNP can be used for risk-stratification in patients with a significant PVL. In general, PVL graded ≥2+ is associated with a dramatically increased 6-month mortality. Therefore, any action to fight against paraprosthetical regurgitation is highly recommended.