Background: Transcatheter aortic valve replacement (TAVR) is the standard therapy for severe aortic stenosis, particularly in elderly patients with comorbidities. Simple biomarkers to predict mid-term mortality are still needed. This study evaluated the prognostic value of the preprocedural neutrophil percentage-to-albumin ratio (NPAR) for 2-year all-cause mortality after TAVR.

Methods: A total of 618 patients undergoing TAVR between 2013 and 2023 were retrospectively analyzed. NPAR was calculated as neutrophil percentage × 100 / albumin (g/dL), and patients were classified into tertiles. The prognostic role of NPAR was assessed using Cox regression, Kaplan–Meier survival analysis, and receiver operating characteristic curves.

Results: Baseline characteristics were similar across tertiles, but higher NPAR was associated with elevated inflammation and lower albumin levels. In multivariable Cox analysis, high NPAR independently predicted 2-year mortality (T3 vs. T1: hazard ratio [HR] 2.75, 95% CI 1.77-4.28; P < .001). In a model including both categorical NPAR and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), tertile 3 of NPAR (HR 2.49, 95% CI 1.61-3.85; P < .001) and STS-PROM (HR 1.31, 95% CI 1.12-1.53; P = .001) remained independent predictors, indicating incremental prognostic value of NPAR beyond established surgical risk scores. Kaplan–Meier curves showed the lowest survival in the highest tertile (35.9% mortality at 2 years). Receiver operating characteristic analysis confirmed NPAR had the best discriminatory ability (area under the curve = 0.703).

Conclusion: Preprocedural NPAR is an independent, low-cost, and readily available biomarker for predicting mid-term mortality after TAVR. Its integration into risk models may improve prediction accuracy and help guide patient management.