Why was this study important?

• Obesity is a major risk factor for subclinical leaflet thrombosis (SLT), hypo-attenuated leaflet thickening (HALT), and paravalvular leak (PVL) following transcatheter aortic valve replacement (TAVR).
• GLP-1/GIP receptor agonists such as tirzepatide have demonstrated potent metabolic and anti-inflammatory effects, including improved endothelial function, reduced prothrombotic activity, and modified epicardial fat deposition.

What question was the study supposed to answer?

• Design: Prospective, randomized, open-label, multicenter clinical trial (TAVR-MET)
• Population: Obese patients (BMI ≥ 30 kg/m²) undergoing transfemoral TAVR with balloon-expandable or self-expanding bioprostheses at eight high-volume centers.
• Exclusion: Prior TAVR, atrial fibrillation requiring long-term anticoagulation, severe renal dysfunction (eGFR < 30 mL/min), or active infection.
• The intervention group received 10 mg once weekly, initiated 4 weeks before TAVR, and continued for 12 months. All patients received standard antithrombotic therapy (DAPT or SAPT per guideline).

What did the study show?

• Tirzepatide therapy initiated pre-TAVR and continued post-procedure significantly reduced subclinical leaflet thrombosis and PVL in obese patients, possibly via anti-inflammatory and metabolic mechanisms.
• The TAVR-MET trial provides the first evidence that metabolic modulation can improve bioprosthetic valve healing and hemodynamics in obesity-associated aortic stenosis.