Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves
Recommended Citation
Abbas AE, Kaneko T, Khalili H, Kapadia SR, Babaliaros VC, Greenbaum AB, Schwann TA, Yadav P, Moussa ID, Reed GW, Laham RJ, Morse MA, Villablanca P, Rodriguez E, Depta JP, McCabe JM, Bapat VN, Thourani VH, Krishnaswamy A. Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves. Circ Cardiovasc Interv. 2026;19(3):015945.
Document Type
Article
Publication Date
3-1-2026
Publication Title
Circ Cardiovasc Interv
Keywords
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
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 are associated with lower ejection fraction and increased 5-year mortality following aortic valve-in-valve replacement compared with higher MG in a nonlinear fashion. Incorporating data on ejection fraction with PPM and MG is important before determining the need for valve optimization.
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
ePublication
ePub ahead of print
Volume
19
Issue
3
First Page
015945
Last Page
015945
