Registry Evaluates Valve Hemodynamic Deterioration After TAVR

February 9, 2016—Findings from a multicenter registry investigating the incidence, timing, and predictors of valve hemodynamic deterioration (VHD) after transcatheter aortic valve replacement (TAVR) were published by Maria Del Trigo, MD, et al in the Journal of the American College of Cardiology (JACC, 2016;67:644–655).

The investigators found that there was a mild but significant increase in transvalvular gradients over time after TAVR, and concluded that the lack of anticoagulation therapy, a valve-in-valve procedure, a greater body mass index, and the use of a 23-mm transcatheter valve were associated with higher rates of VHD after TAVR.

According to the investigators, this multicenter registry included 1,521 patients (48% male; 80 ± 7 years of age) who underwent TAVR. Mean echocardiographic follow-up was 20 ± 13 months (minimum: 6 months). Echocardiographic examinations were performed at discharge, at 6 to 12 months, and yearly thereafter. Annualized changes in mean gradient (mm Hg/year) were calculated by dividing the difference between the mean gradient at last follow-up and the gradient at discharge by the time between examinations.

VHD was defined as a ≥ 10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessment.

As summarized in JACC, the overall mean annualized rate of transprosthetic gradient progression during follow-up was 0.30 ± 4.99 mm Hg/year. A total of 68 patients met the criteria of VHD (incidence: 4.5% during follow-up). The absence of anticoagulation therapy at hospital discharge (P = .002), a valve-in-valve (TAVR in a surgical valve) procedure (P = .032), the use of a 23-mm valve (P = .016), and a greater body mass index (P = .001) were independent predictors of VHD.

Further prospective studies are required to determine whether a specific antithrombotic therapy after TAVR may reduce the risk of VHD, advised the investigators in JACC.