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

Interventions for valvular disease and heart failure

Predictors of haemodynamic structural valve deterioration following transcatheter aortic valve implantation with latest-generation balloon-expandable valves

EuroIntervention 2020;15:1233-1239. DOI: 10.4244/EIJ-D-19-00710

1. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; 2. Hospital de Cardiología, Centro Médico Nacional Siglo XXI (Instituto Mexicano del Seguro Social, IMSS), Ciudad de México, México; 3. Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; 4. Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Vienna, Austria; 5. DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany; 6. Klinik für Innere Medizin I, St. Johannes-Hospital, Dortmund, Germany

Aims: Elevated gradients have been proposed to be associated with haemodynamic structural valve deterioration (SVD) after transcatheter aortic valve implantation (TAVI); however, data regarding their characterisation remain scarce. This study sought to investigate the prevalence and predictors of moderate or greater SVD and the prevalence of valve thrombosis during follow-up after TAVI with balloon-expandable valves.

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

Conclusions: The prevalence of moderate or greater haemodynamic 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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