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Publications

Journal Article Ahead of print

PubMed: 42186872 DOI: 10.4244/EIJ-D-25-01370

Prognostic value of early haemodynamic valve deterioration after TAVI.

EuroIntervention

Authors: Antonin Trimaille, Olivier Morel, Alberto Alperi, Gabriela Veiga-Fernandez, Luis Nombela-Franco, Victoria Vilalta, Antonio Munoz-Garcia, Jorge Nuche, Anna Franzone, Marina Urena, Lluis Asmarats, Ander Regueiro, Maria Del Trigo, Vincent Auffret, David Del Val, Vicenç Serra, Adrien Carmona, Pablo Avanzas, Victor Fradejas-Sastre, Ivan Sanchez, Michele Trichilo, Nicolas Maneiro, Maddalena Immobile Molaro, Quentin Fischer, Dabit Arzamendi, Eduardo Flores-Umanzor, Juan Francisco Oteo, Maxime Nolf, Fernando Alfonso, Pedro Díaz Pockels, Camil Elkadiri, Pedro Cepas-Guillén, Marisa Avvedimento, Josep Rodés-Cabau

Affiliations

  • Quebec Heart & Lung Institute, Laval University, Quebec City, Canada.
  • Department of Cardiovascular Medicine, Nouvel Hôpital Civil Strasbourg, University Hospital Strasbourg, Strasbourg, France.
  • Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
  • Cardiology Department, Hospital Marqués de Valdecilla, Santander, Spain.
  • Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
  • Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain.
  • Cardiology Department, Hospital Regional Virgen de la Victoria, Malaga, Spain.
  • Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, Spain, Centro de Investigación Biomédica En Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
  • Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
  • Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.
  • Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
  • Cardiology Department, Hospital Puerta de Hierro, Madrid, Spain.
  • Department of Cardiology, University of Rennes, Rennes University Hospital, Rennes, France.
  • Cardiology Department, Hospital de La Princesa, Madrid, Spain.
  • Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.

Abstract

BACKGROUND

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.

AIMS

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

METHODS

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.

RESULTS

Among 7,392 patients, early HVD was observed in 231 patients (3.1%). Body mass index (adjusted odds ratio [aOR] per 5 kg/m 2 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.

CONCLUSIONS

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.

MeSH

Echocardiography, Transcatheter Aortic Valve Replacement