Invasive and Echocardiographic Mean Transvalvular Pressure Gradients of Different Transcatheter Aortic Valve...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Evaluation

Background:

• Transcatheter aortic valve replacement (TAVR) requires accurate prosthesis performance assessment.
• Comparing intraprocedural invasive measurements with echocardiography is crucial for TAVR outcomes.
• Evaluating balloon-expandable (BE) versus self-expandable (SE) valves, especially in different aortic annulus sizes, is important.

Purpose of the Study:

• To assess the effectiveness of intraprocedural invasive measurements (IC MPGs, DD) versus echocardiography for TAVR prosthesis evaluation.
• To compare TAVR outcomes between BE and SE valves, stratified by aortic annulus size.
• To determine the diagnostic value of diastolic delta (DD) for postprocedural aortic regurgitation.

Main Methods:

• Retrospective analysis of 926 TAVR patients (2012-2021).
• Categorization into BE (n=301) and SE (n=625) valve groups.
• Measurement of intraprocedural MPG, postprocedural echocardiographic MPG (EC MPG), and aortic regurgitation; annuli classified as small (≤23 mm) or large (≥24 mm).

Main Results:

• EC MPG was higher than IC MPG, with weak correlation between modalities.
• SE valves showed lower EC MPG than BE valves.
• DD was higher in the BE group, but showed no significant correlation with aortic regurgitation.

Conclusions:

• Intraprocedural invasive measurements offer reliable, immediate TAVR prosthesis assessment but underestimate gradients.
• Newer SE valves demonstrate comparable performance to BE valves, particularly in small annuli.
• Diastolic delta (DD) lacks diagnostic value for assessing postprocedural aortic regurgitation.