Transvalvular Gradients for Balloon-Expandable and Self-Expanding Valves

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Self-expanding valves (SEVs) are often presumed to offer superior hemodynamics compared to balloon-expandable valves (BEVs).
• Direct comparison of invasive hemodynamic parameters between similarly sized SEVs and BEVs post-transcatheter aortic valve replacement (TAVR) is crucial for clinical decision-making.

Purpose of the Study:

• To compare invasive transvalvular gradients between SEVs and BEVs in patients undergoing TAVR, focusing on similarly sized devices.
• To evaluate immediate hemodynamic performance and early postoperative echocardiographic gradients between the two valve types.

Main Methods:

• Retrospective analysis of 499 patients who underwent TAVR at two centers, with available invasive hemodynamic data.
• Inclusion of patients with similarly sized SEVs and BEVs.
• Assessment of immediate invasive gradients and postoperative (within 24 hours) Doppler gradients via echocardiography.

Main Results:

• Immediate invasive hemodynamic assessment showed similar or marginally lower transvalvular gradients for BEVs compared to SEVs.
• Early postoperative echocardiography (within 24 hours) revealed significantly lower Doppler gradients for SEVs compared to BEVs across all valve sizes.

Conclusions:

• While immediate invasive hemodynamics are comparable, SEVs demonstrate superior hemodynamic performance in the early postoperative period after TAVR.
• The choice between SEVs and BEVs may influence early hemodynamic outcomes, with SEVs showing an advantage in Doppler-derived gradients.