Hemodynamic Variability in Aortic Stenosis and Regurgitation During Transcatheter Aortic Valve Replacement With Self-Expanding Valves

TL;DR

This study shows that patients with aortic regurgitation have better heart valve function after TAVR compared to those with aortic stenosis, especially when the heart valve area is smaller.

Contribution

The study reveals distinct hemodynamic outcomes of TAVR in aortic regurgitation versus aortic stenosis, based on annular anatomy and valve sizing.

Findings

Aortic regurgitation patients had larger postoperative aortic valve areas and lower pressure gradients compared to aortic stenosis patients.

Smaller annuli showed higher prosthesis compression and 20% of patients developed elevated transvalvular gradients at follow-up.

One-year outcomes showed more favorable valve performance in aortic regurgitation patients with suitable annular anatomy.

Abstract

This study investigated the impact of pathological differences between aortic stenosis (AS) and aortic regurgitation (AR) on hemodynamic outcomes following transcatheter aortic valve replacement (TAVR), with a focus on the performance of self-expanding valves relative to annular anatomy.

In this single-center, retrospective study, patients undergoing TAVR for AS or AR were stratified by annulus area into smaller (< 430 cm2) and larger (≥ 430 cm2) subgroups. Valve sizing was based on annular dimensions (≥ 27 mm for AR/smaller annulus; < 27 mm for AS subgroups). Hemodynamic parameters (aortic valve area [AVA], pressure gradients, and velocity) and prosthesis characteristics (sheath size and compression ratio) were evaluated pre- and postoperatively, with 1-year follow-up.

The AR group required larger sheaths (p = 0.006) and demonstrated superior hemodynamics compared to the AS group: larger postoperative AVA (3.0 ± 0.4 vs. 2.2 ± 0.5  and 2.1 ± 0.6 cm2 in larger and smaller annuli, respectively, p < 0.001); lower maximum (9.7 ± 4.3 vs. 15.8 ± 9.2 and 18.8 ± 10.8 mmHg in larger and smaller annuli, respectively, p < 0.001) and mean gradients (7.8 ± 4.4 mmHg vs. others, p < 0.001); and reduced aortic velocity (1.60 ± 0.43 vs. others, p = 0.038). Smaller annuli exhibited higher prosthesis compression (0.88 ± 0.04 vs. 0.84 ± 0.04 in AR and 0.8 ± 0.06 in larger annulus, p < 0.001), with 20% (n = 8) developing elevated transvalvular gradients (> 20 mmHg) at follow-up.

One-year outcomes revealed distinct hemodynamic profiles post-TAVR between AR and AS groups based on annular size. Patients with AR exhibited more favorable valve performance, supporting TAVR in younger, low-risk patients with AR who have suitable annular anatomy.

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