[How to deal with elevated gradient following TAVR?]

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve implantation (TAVI) is a primary treatment for severe aortic stenosis.
• Expanding TAVI indications necessitate durable transcatheter heart valve (THV) function.
• Secondary THV dysfunction, indicated by elevated transvalvular gradients, requires careful evaluation.

Purpose of the Study:

• To outline diagnostic strategies for secondary transvalvular gradient elevation post-TAVI.
• To present management approaches for diverse causes of secondary THV dysfunction.
• To illustrate clinical decision-making through case studies.

Main Methods:

• Review of TAVI outcomes and secondary THV dysfunction mechanisms.
• Application of VARC-3 criteria for classifying THV dysfunction.
• Case-based illustration of diagnostic workup and treatment selection.

Main Results:

• Secondary THV dysfunction presents with increased transvalvular gradients.
• Common causes include structural valve deterioration, non-structural dysfunction, thrombosis, and endocarditis.
• Systematic diagnosis is key to effective management.

Conclusions:

• Understanding the mechanisms of secondary THV dysfunction is crucial for TAVI success.
• Prompt and accurate diagnosis leads to appropriate management strategies.
• Ensuring THV longevity is vital with expanding TAVI use in lower-risk patients.