Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves
Year: 2026
Type: article
Study design: Observational Study
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: <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.
Authors: Amr E. Abbas, Tsuyoshi Kaneko, Houman Khalili, Samir R. Kapadia, Vasilis C. Babaliaros, Adam B. Greenbaum, Thomas A. Schwann, Pradeep Yadav, Issam D. Moussa, Grant W. Reed, Roger J. Laham, Michael A. Morse, Pedro Villablanca, Evelio Rodriguez, Jeremiah P. Depta, James M. McCabe, Vinayak N. Bapat, Vinod H. Thourani, Amar Krishnaswamy
Institutions: Beaumont Hospital, Royal Oak, Washington University in St. Louis, Memorial Healthcare System, Cleveland Clinic, Emory University Hospital Midtown, Emory University Hospital, Piedmont Atlanta Hospital, University of Illinois Urbana-Champaign, Beth Israel Deaconess Medical Center, Harvard University, Saint Thomas West Hospital, Henry Ford Hospital, University of Washington, Minneapolis Heart Institute Foundation
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7128386424