Incidence, Mechanisms, and Predictors of Mean Systolic Gradients ≥20 mm Hg after Transcatheter Aortic Valve Implantation
Section snippets
Methods
The study was approved by the Mayo Clinic Institutional Review Board. All patients undergoing TAVI at Mayo Clinic, Minnesota between November 2008 and August 2015 who had at least 1 transthoracic echocardiogram (TTE) at Mayo Clinic after TAVI were considered for the study. Patients who had valve-in-valve procedure and those who followed-up at different institutions were excluded from the analysis. Baseline demographic data, TAVI procedural details (type and size of TAV, implantation route,
Results
A total of 621 patients underwent TAVI at our institution during the study period. Of these, 424 patients who had TAVI in native valve and baseline (predischarge) and at least 1 follow-up TTE at our institution were included in the study; 37% had 3 or more echocardiograms during follow-up. The reasons for exclusion were: valve-in-valve procedure (n = 114), post-TAVI TTE not performed because of death before 1st-month follow-up (n = 18), SAVR (n = 1), and patient having a follow-up at different
Discussion
The major findings of our study are the following: (1) the incidence of mean systolic Doppler gradients ≥20 mm Hg post-TAVI was 8% and nearly 22% of patients had more than 1 mechanism of mean systolic Doppler gradients ≥20 mm Hg; (2) the most common mechanisms in order of frequency were patient prosthesis mismatch, high cardiac output, prosthetic and periprosthetic regurgitation (more than mild) and stenosis; (3) patients with baseline mean systolic Doppler gradients ≥20 mm Hg (on predischarge
Disclosures
Nothing relevant to disclose.
Acknowledgement
None.
References (21)
- et al.
Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort a of the PARTNER trial (placement of aortic transcatheter valves)
J Am Coll Cardiol
(2013) - et al.
Transcatheter aortic valve replacement is associated with fewer hospital days: a report from STS/ACC TVT registry
J Am Coll Cardiol
(2016) - et al.
Comprehensive echocardiographic assessment of normal transcatheter valve function
JACC Cardiovasc Imaging
(2019) - et al.
Incidence, timing, and predictors of valve hemodynamic deterioration after transcatheter aortic valve replacement: multicenter registry
J Am Coll Cardiol
(2016) - et al.
Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography
J Am Soc Echocardiogr
(2009) - et al.
Bioprosthetic valve thrombosis versus structural failure: clinical and echocardiographic predictors
J Am Coll Cardiol
(2015) - et al.
5-Year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients
J Am Coll Cardiol
(2018) - et al.
Anticoagulation after surgical or transcatheter bioprosthetic aortic valve replacement
J Am Coll Cardiol
(2019) - et al.
Thrombus formation following transcatheter aortic valve replacement
JACC Cardiovasc Interv
(2015) - et al.
Trial design: rivaroxaban for the prevention of major cardiovascular events after transcatheter aortic valve replacement: rationale and design of the GALILEO study
Am Heart J
(2017)
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Rationale and design of the SMall Annuli Randomized To Evolut or SAPIEN Trial (SMART Trial)
2022, American Heart JournalCitation Excerpt :Similar results have been shown in the Italian Registry with Edwards SAPIEN and SAPIEN XT valves.36 Comparative studies have demonstrated lower long-term gradients and a reduced incidence of severe prosthesis-patient mismatch with SE-TAVR compared with BE-TAVR.18,37-40 Results from the CHOICE Trial, which randomized patients to SE or BE-TAVR, demonstrated superior 5-year hemodynamics with SE-TAV compared to BE-TAV (mean gradient, 6.9 mmHg vs 12.2 mmHg, P = 0.001; effective orifice area, 1.9 cm2 vs 1.6 cm2, P = 0.02).38