Residual postprocedural gradients after transcatheter aortic valve implantation: a small number with a big impact?

The recently updated European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) Guidelines for the management of valvular heart disease recommend transcatheter aortic valve implantation (TAVI) as the preferred treatment strategy for patients aged ≥70 years with tricuspid aortic valve stenosis across the entire operative risk spectrum1. In this context, lifetime management has become a key aspect, as the life expectancy of most patients likely now exceeds valve durability, mandating long-term planning for potential future valve reinterventions. Due to the lack of solid evidence, however, the long-term durability of transcatheter heart valves (THVs) remains a matter of debate. Available studies with up to ten years of follow-up provide reassuring results with low rates of structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) after TAVI2. However, as TAVI expands to younger patients, a deeper understanding of THV durability and its determinants becomes critical to inform individualised lifetime management strategies.

In this issue of EuroIntervention, Palmerini and colleagues present an important study exploring the association between early residual mean postprocedural gradients (ERMPGs) and long-term SVD rates, as well as the...