The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Hemodynamic structural valve deterioration following transcatheter aortic valve implantation with latest-generation balloon-expandable valves

DOI: 10.4244/EIJ-D-19-00710

1. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
2. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
3. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
4. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
5. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
6. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
7. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Hospital de Cardiología, Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Ciudad de México, México
8. Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
9. Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Vienna, Austria
10. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
11. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
12. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Klinik für Innere Medizin I, St.-Johannes-Hospital, Dortmund, Germany
13. Klink für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany, Germany
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Aims: Elevated gradients have been proposed to be associated with hemodynamic structural valve deterioration (SVD) after transcatheter aortic valve implantation (TAVI) and data regarding their characterization remain scarce. 

Methods and results: 691 patients undergoing transfemoral TAVI were enrolled. The primary endpoint was moderate or severe hemodynamic SVD during 12-month follow-up after TAVI, defined as (I) mean transvalvular gradient ≥20 mmHg or (II) mean transvalvular gradient change ≥10 mmHg. The primary endpoint was observed in 10.3% after TAVI. Use of 20mm valve, valve-in-valve procedure and oral anticoagulation (OAC) were independently associated with hemodynamic SVD, whereas valve-in-valve procedure and OAC were the only significant variables after accounting for death as a competing event. OAC was significantly associated with both, hemodynamic SVD (RR 8.65; p=0.004) and death (RR 3.57; p=0.06), whereas valve-in-valve procedure was only associated with hemodynamic SVD (RR 52.76; p<0.001). Valve thrombosis was present in 0.87% (6/691) of all patients. 

Conclusions:  The prevalence of moderate or greater hemodynamic SVD during the first 12 months after TAVI is 10.3%. Procedural factors and pharmacotherapy seem to play a key role during manifestation. Future studies should focus on the underlying mechanisms.

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