# 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.

## Key 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.