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

We thank Güner et al for their interest in our prospective multicentre Fermeture de Fuite ParaProthétique (FFPP) registry evaluating transcatheter paravalvular leak closure (PVLc)1 and for their thoughtful and constructive comments. We welcome the opportunity to clarify several methodological points raised in their correspondence.

We fully agree that PVLc management remains complex and that outcomes depend on multiple factors, including patient selection, anatomical characteristics, procedural strategy, and imaging assessment. In this context, we believe that the prospective design of the FFPP registry, its complete follow-up up to two years, and the use of clinically meaningful endpoints provide robust real-world evidence in a high-risk population undergoing transcatheter PVLc2.

Several concerns deserve clarification. First, regarding endpoint definitions, we would like to emphasise that Academic Research Consortium (ARC) criteria were explicitly acknowledged and applied in our methodology. In the FFPP registry, echocardiographic assessment of PVL severity followed the Valve Academic Research Consortium expert consensus3, as detailed in both the present manuscript and in the initial publication from the same prospective registry focusing on short-term outcomes4. Our definitions of technical and clinical...