High Gradients After Valve-in-Valve

One of the limitations of aortic bioprostheses is their durability. When these devices fail, percutaneous valve implantation is a valid strategy. However, it has been shown that there may be high gradients involved.

Intervención tricuspídea heterotópica: Resultados de TricValve a un año

This gradient increase has been associated with worse outcomes and higher mortality rates, as observed in the PARTNER 2 study at 12 months. This, however, was not the case at the 5-year follow-up, highlighting the lack of conclusive evidence in this scenario.

An analysis was conducted on 12,122 patients who underwent transcatheter aortic valve implantation (TAVI) in surgically bioprosthetic aortic valves with severe structural deterioration. The primary endpoint at 12 months included all-cause death, stroke, myocardial infarction, or valve reintervention.

Patients were divided into four groups according to mean gradient: <10 mmHg (2272 patients), between 10 and <20 mmHg (5803 patients), between 20 and <30 mmHg (2889 patients), and >30 mmHg (1158 patients).

The mean age was 76 years, and 61% of patients were men. While groups were similar in many aspects, those with a post-procedural high gradient tended to have a higher initial gradient and a higher body mass index. They more frequently had a history of smoking, more aortic insufficiency, and an aortic valve area <1 cm2.

Read also: Glycemic Control and Coronary Stent Failure.

On the other hand, patients with a low gradient had higher rates of atrial fibrillation, lower ejection fraction, larger valve rings, elevated hemoglobin levels, and more urgent or emergent procedures.

The primary endpoint at 12 months was 11.1%, with a mortality rate of 7.6%, a myocardial infarction rate of 1%, and a valve reintervention rate of 1.2%.

A gradient ≥20 mmHg was associated with increased mortality at 12 months (adjusted hazard ratio [HR], 1.017 [95% confidence interval, 1.005–1.030] per mmHg; P=0.007).

Read also: Antiplatelet Treatment with Ticagrelor vs. Clopidogrel in Patients with Chronic Coronary Syndrome.

An adjusted analysis according to gradient (<10 mmHg, between 10 and >20 mmHg, between 20 and <30 mmHg, and ≥30 mmHg) showed increased mortality when the gradient was <10 mmHg or ≥30 mmHg.

Conclusion

In conclusion, there is a complex and nonlinear relationship between post-TAVI mean gradient in surgically deteriorated bioprosthetic aortic valves and clinical outcomes. There is a relative increase in adverse events in patients with low or extremely high gradients. Further studies are needed to better understand the factors influencing this relationship, especially in patients with low gradients.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Impact of Elevated Gradients After Transcatheter Aortic Valve Implantation for Degenerated Surgical Aortic Valve Bioprostheses.

Reference: Riyad Yazan Kherallah, et al. Circ Cardiovasc Interv. 2024;17:e013558. DOI: 10.1161/CIRCINTERVENTIONS.123.013558.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Repair: OneForAll Registry

Courtesy of Dr. Juan Manuel Pérez. Mitral transcatheter edge-to-edge repair (M-TEER) is an effective option for patients with severe mitral regurgitation who are at high...

Left Bundle Branch Block after TAVR: What Is Its Impact?

Courtesy of Dr. Juan Manuel Pérez. Left bundle branch block (LBBB) is a common complication following transcatheter aortic valve replacement (TAVR), which can be either...

Multicenter Experience with 3D Intracardiac Echocardiography for Guiding Interventional Cardiac Procedures

Courtesy of Dr. Juan Manuel Pérez. Imaging techniques play a fundamental role in interventional cardiac procedures. Intracardiac echocardiography (ICE) appears as an alternative to transesophageal...

Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening

Courtesy of Dr. Juan Manuel Pérez. Despite the available long term followup data on of transcatheter aortic valve replacement (TAVR), bioprosthesis durability continues under debate....

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...