Temporal Changes in Transvalvular Pressure Gradients in Balloon-Expandable and Self-Expanding Transcatheter Aortic...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Transcatheter aortic valve replacement (TAVR) is a key treatment for severe aortic stenosis.
• Self-expanding valves (SEV) generally show lower long-term mean gradients (MG).
• The temporal dynamics and influencing factors of post-TAVR gradient changes are not fully understood.

Purpose of the Study:

• To investigate the timing and magnitude of mean gradient (MG) changes after TAVR.
• To compare these hemodynamic changes across different valve types (BEV vs. SEV), sizes, and degrees of aortic calcification.

Main Methods:

• Retrospective analysis of 288 patients undergoing TAVR.
• Mean gradient (MG) measured by echocardiography at three time points: immediately post-deployment, Day 1, and 1-2 months.
• Analysis included valve type, size, and calcium score, using statistical tests and logistic regression for confounder adjustment.

Main Results:

• Balloon-expandable valves (BEV) demonstrated significantly higher early and intermediate mean gradient increases compared to self-expanding valves (SEV).
• Smaller valve sizes, specifically 23mm BEV, were associated with the most substantial gradient elevations.
• Aortic calcium burden showed minimal impact on early and no effect on intermediate mean gradient changes.

Conclusions:

• Hemodynamic shifts post-TAVR commence within 24 hours, with BEV exhibiting more pronounced increases in mean gradient (MG) than SEV.
• Valve type and size are primary determinants of post-TAVR gradient behavior.
• Calcium burden appears to play a minor role in these early hemodynamic alterations.