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

Transcatheter aortic valve replacement (TAVR) is evolving as a preferred treatment option for severe aortic stenosis. While self-expanding valves (SEV) are associated with lower long-term mean gradients (MG), the timing and mechanisms of gradient changes across valve types remain unclear.

To evaluate the timing and extent of post-TAVR mean gradient changes across valve types, sizes, and calcium burden.

We conducted a retrospective analysis of 288 patients who underwent TAVR. MG was measured using echocardiography immediately post-deployment (TEE), on Day 1, and at 1-2 months postprocedure (TTE). Early ΔMG was defined as the difference between post-deployment TEE and Day 1 TTE; intermediate ΔMG as the difference between post-deployment TEE and 1-month TTE. Comparisons were performed by valve type, valve size, and calcium score using chi-square tests for categorical variables and t-tests for continuous variables. Logistic regression was used to adjust for potential confounding factors.

Patients receiving balloon-expandable valves (BEV) had significantly greater early ΔMG (7.65 ± 0.75 mmHg) compared to SEV (2.55 ± 0.65 mmHg; p < 0.0001). Intermediate ΔMG was also higher in BEV (8.0 ± 0.7 vs. 2.2 ± 1.1 mmHg; p < 0.0001). Smaller valve sizes, particularly the 23 mm BEV, were associated with the largest gradient increases. Calcium score had a minimal impact on early MG and no effect on intermediate MG.

Hemodynamic changes begin within the first 24 h after TAVR, with BEV showing more pronounced early and intermediate increases in MG compared to SEV. These findings suggest that valve type and size are major drivers of post-TAVR gradient behavior, whereas calcium burden plays a limited role.