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Different Types of Aortic Valve Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement

Kimberley I Hemelrijk1, Hugo M Aarts1,2, Gijs M Broeze1

  • 1Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.

Structural Heart : the Journal of the Heart Team
|March 20, 2026
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) outcomes vary by aortic stenosis (AS) type. One-year mortality was higher for low-gradient AS with impaired ejection fraction, but similar for other discordant AS types compared to high-gradient AS.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve replacement (TAVR) is a standard treatment for high-gradient aortic stenosis (AS).
  • Limited data exist on TAVR outcomes for patients with discordant AS.
  • This study analyzes TAVR outcomes across different AS classifications.

Purpose of the Study:

  • To investigate the clinical outcomes of patients undergoing TAVR with various types of AS.
  • To compare TAVR results between discordant and concordant high-gradient AS.
  • To identify specific AS subgroups associated with different TAVR prognoses.

Main Methods:

  • Analysis of the CENTER2 patient-level database (n=15,233) of TAVR procedures.
  • Classification of patients into four AS subgroups: low-gradient AS with preserved or impaired left ventricular ejection fraction (LVEF), discordant high-gradient AS, and concordant high-gradient AS.
  • Comparison of 1-year mortality and major bleeding rates across AS subgroups.

Main Results:

  • 17.9% of TAVR patients had low-gradient AS, and 0.9% had discordant high-gradient AS.
  • No significant difference in 1-year mortality between discordant AS and concordant high-gradient AS (13.1% vs. 11.9%, p=0.08).
  • Higher 1-year mortality in low-gradient AS with impaired LVEF (15.9%) versus concordant high-gradient AS (11.9%, p=0.01).
  • Concordant high-gradient AS had higher major bleeding rates (6.7%) compared to both low-gradient AS subgroups (4.0-5.4%, p<0.001 and p=0.04).

Conclusions:

  • Discordant AS, excluding low-gradient AS with impaired LVEF, shows similar 1-year mortality to concordant high-gradient AS after TAVR.
  • Low-gradient AS with impaired LVEF is associated with increased 1-year mortality post-TAVR.
  • These findings refine risk stratification for TAVR patients with varied AS presentations.
Abstract

Keywords:
Aortic stenosisLow gradientTAVR

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