Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves

Department

Cardiology

Document Type

Article

Publication Title

Circulation. Cardiovascular Interventions

Abstract

Background: Lower (< 10 mm Hg) discharge echocardiographic mean gradients (MGs) following transcatheter aortic valve replacement with balloon-expandable valves are associated with lower ejection fraction and higher 5-year mortality compared with higher gradients. Using the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, we studied the relationship between echocardiographic MG and patient prosthesis mismatch (PPM) following transcatheter aortic valve-in-valve replacement and clinical outcomes.

Methods: Patients who underwent aortic valve-in-valve replacement with a balloon-expandable valve from July 2015 to December 2023 in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were included. Adjusted Cox models with regression splines explored the relationship between MG and 5-year mortality. Kaplan-Meier estimates and adjusted hazard ratios compared the occurrence of 5-year mortality between gradient cutoffs and PPM presence.

Results: A total of 13 054 patients were included; spline curves demonstrated a nonlinear relationship between discharge MG and 5-year mortality. Kaplan-Meier curves suggested higher 5-year mortality with MG < 10 mm Hg compared with MG ≥ 10 mm Hg (hazard ratio, 1.15 [95% CI, 1.02-1.29]; P=0.024). MG < 10 mm Hg was associated with lower ejection fraction compared with higher MG (50.4±13.9 versus 53.2±12.8; P< 0.0001). Severe PPM and MG ≥20 mm Hg were not associated with worse 5-year outcomes compared with none/moderate PPM or MG ≤ 20 mm Hg, respectively.

Conclusions: Discharge MG < 10 mm Hg is associated with lower ejection fraction and increased 5-year mortality following aortic valve-in-valve replacement compared with higher MG in a nonlinear fashion. Severe PPM and MG > 20 mm Hg were not associated with worse 5-year clinical outcomes. Incorporating data on ejection fraction with PPM and MG is important before determining the need for valve optimization.

First Page

e015945

DOI

10.1161/CIRCINTERVENTIONS.125.015945

Volume

19

Issue

3

Publication Date

3-1-2026

Medical Subject Headings

Humans; Male; Female; Heart Valve Prosthesis; Transcatheter Aortic Valve Replacement; Aortic Valve; Treatment Outcome; Aged, 80 and over; Aged; Aortic Valve Stenosis; Registries; Time Factors; Risk Factors; Hemodynamics; Prosthesis Design; Risk Assessment; Balloon Valvuloplasty; Retrospective Studies; Recovery of Function

PubMed ID

41657207

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