Letter: Transcatheter paravalvular leak closure – insights on selection criteria, imaging, and comparative outcomes

We read with interest the prospective multicentre registry by Albenque et al reporting medium-term outcomes and prognostic factors after transcatheter paravalvular leak (PVL) closure1. The authors should be acknowledged for providing one of the few prospective datasets with a 2-year follow-up in this challenging patient population. Their finding that early clinical success at one month is the strongest predictor of adverse outcomes is clinically relevant and consistent with prior observational data23. However, several methodological aspects merit further clarification.

First, the definitions of technical and clinical success deviate in part from the Academic Research Consortium (ARC) and ARC-aligned frameworks commonly used in contemporary structural heart studies23. The use of standardised endpoint definitions would improve comparability across registries and enhance external validity. In addition, the absence of a surgical comparator arm limits the interpretation of outcomes in the context of current evidence, suggesting comparable long-term survival but higher early mortality with redo-surgery34. Even a non-randomised, propensity-adjusted comparison could have provided additional clinical perspective.

Second, patient selection criteria for transcatheter versus surgical PVL closure are not fully detailed....