Prognostic value of early haemodynamic valve deterioration after TAVI

Early haemodynamic valve deterioration (HVD) was associated with worse clinical outcomes and bioprosthetic durability after transcatheter aortic valve implantation (TAVI) in a single-centre study.

The aim of this study was to evaluate the incidence, predictors, and prognostic impact of early HVD in a large-scale TAVI population.

We analysed the data from an international, multicentre registry including consecutive patients from 16 centres undergoing TAVI. Early HVD was defined as an increase of at least 10 mmHg in the mean transaortic gradient on echocardiography performed within the first three months after TAVI, compared with the discharge echocardiography. The primary endpoint was the valve-related long-term clinical efficacy according to the Valve Academic Research Consortium 3.

Among 7,392 patients, early HVD was observed in 231 patients (3.1%). Body mass index (adjusted odds ratio [aOR] per 5 kg/m² increase 1.15, 95% confidence interval [CI]: 1.02-1.30), prosthesis size <26 mm (aOR 1.96, 95% CI: 1.43-2.70), valve-in-valve procedure (aOR 2.76, 95% CI: 1.83-4.08), and the absence of anticoagulation at discharge (aOR 1.64, 95% CI: 1.22-2.22) were independent predictors of early HVD. After a median follow-up of 4 years (interquartile range 2-5), early HVD was independently associated with a lower valve-related long-term clinical efficacy (subdistribution hazard ratio [sHR] 0.42, 95% CI: 0.32-0.56), and a higher risk of stroke (sHR 2.32, 95% CI: 1.51-3.57), stage 2 or 3 (sHR 2.74, 95% CI: 2.10-3.57) or stage 3 bioprosthetic valve dysfunction (sHR 3.53, 95% CI: 2.15-5.79), and bioprosthetic valve failure (sHR 3.04, 95% CI: 2.06-4.52). Consistent findings were observed in a propensity score-matched cohort and in different sensitivity analyses.

Early HVD was observed in 3.1% of patients and was associated with adverse clinical and haemodynamic outcomes after TAVI. These findings validate the clinical relevance of detecting early HVD and the necessity for further research to guide optimal management of these patients.