Paravalvular leak (PVL) remains an important limitation of transcatheter aortic valve implantation (TAVI), despite major advances in prosthesis design, imaging guidance, and implantation technique. Although the incidence of moderate and severe PVL has substantially declined with newer-generation valves, mild PVL continues to be frequently observed in contemporary practice and is increasingly recognised as clinically relevant. Multiple studies have demonstrated an association between even mild PVL and adverse outcomes, particularly heart failure (HF) hospitalisation, suggesting that conventional grading systems may underestimate its true haemodynamic burden. Beyond simple regurgitant volume, PVL is characterised by eccentric high-velocity flow, turbulence, impaired pressure recovery, and reduced haemodynamic efficiency. These effects may be particularly important in vulnerable phenotypes such as patients with heart failure with preserved ejection fraction (HFpEF), concentric left ventricular hypertrophy, or low-flow states, in whom small regurgitant volumes can result in disproportionate increases in filling pressures and symptomatic deterioration. This review summarises contemporary evidence regarding the prevalence, diagnosis, haemodynamic impact, and clinical consequences of PVL after TAVI. Differences across valve platforms, predictors of PVL, and current management strategies are also discussed. Particular emphasis is placed on the limitations of pressure-based assessment and the need for a patient-specific, flow-oriented approach aligned with contemporary endpoint definitions such as those proposed by VARC-3.

Background: Patients undergoing urgent transcatheter aortic valve implantation (TAVI) represent a clinically high-risk population with increased peri-procedural morbidity. Whether an early discharge strategy is feasible and safe remains unclear. We evaluated the feasibility of early discharge in patients undergoing urgent transcatheter aortic valve implantation. Methods: This single-centre observational cohort study included 279 consecutive patients undergoing urgent TAVI (mean age 81 ± 7 years; 155 [56%] male). Patients were stratified according to post-TAVI length of stay into next-day discharge or prolonged hospitalisation (>1 day). Data were prospectively collected and the primary end point was 30-day all-cause mortality. Results: Among 279 urgent TAVI patients, 62 (22%) were discharged the next day and 217 (78%) had prolonged hospitalisation. Baseline clinical and echocardiographic characteristics were similar between the two groups. Among the 279 patients surviving to discharge assessment, 30-day mortality was 0.4%, with no significant difference between the next-day and longer-stay groups. Patients in the short hospital stay group had an 11% complication rate compared to 30% in the long stay one. Unlike stroke or pacemaker implantation, vascular complication was an independent predictor of extended in-hospital length of stay [Beta coefficient 3.41, 95% CI (0.98 to 5.85), p = 0.006]. Conclusions: Next-day discharge appears feasible in carefully selected patients undergoing urgent TAVI and was not associated with excess 30-day mortality in this observational cohort. Prospective multi-centre studies are required to validate these findings and establish standardised discharge criteria.

Background: Single-access transfemoral transcatheter aortic valve implantation (TAVI) reduces the need for multiple vascular access and therefore, the related risk of related complications. However, the impact of patient age on its clinical outcomes remains uncertain. Methods: This is a secondary analysis of previously reported propensity score matched study comparing clinical outcomes of single- versus dual-access transfemoral TAVI using SAPIEN-3-Ultra. We examined the relation between patient age, access strategy and outcomes—specifically, 30-day safety endpoint according to the Valve Academic Research Consortium 3 (VARC-3) and major adverse cardiovascular events (MACE), defined as death, permanent pacemaker, neurological or vascular complications—using logistic regression interaction analyses, and restricted cubic spline modelling. Results: A total of 204 patients (propensity score-matched cohort) were included in the study. The elderly group were more likely to have hypertension, peripheral vascular disease or stroke. The use of single access was comparable. The elderly cohort demonstrated a tendency toward longer fluoroscopy and procedural times compared with the non-elderly group. This pattern likely reflects the greater technical complexity and heightened procedural caution often associated with older patients, including more challenging vascular anatomy and the need for careful device handling. Although not statistically significant, these findings remain clinically meaningful and are consistent with the notion that procedures in elderly patients frequently require more meticulous planning and execution. There was a significant interaction between access strategy and age in reducing MACE, but not in VARC-3 safety outcomes. Single access was associated with a significant reduction in MACE (5.4% vs. 26.7%, p = 0.015) with comparable technical and safety outcomes when compared with elderly patients who underwent dual-access TAVI. Conclusions: Single-access TAVI was linked to favourable early outcomes, maintained procedural success, and suggested a possible age-dependent pattern in the occurrence of MACE. Our findings support the need for randomised studies to demonstrate superiority of single- versus dual-access TAVI, particularly in the elderly population.