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Valve hemodynamic deterioration risk higher after TAVR
In patients who have undergone transcatheter aortic valve replacement, lack of anticoagulation therapy, use of a smaller valve and higher BMI may be associated with increased risk for valve hemodynamic deterioration.
Researchers analyzed, the incidence, predictors and timing of valve hemodynamic deterioration in a multicenter registry of 1,521 consecutive patients who underwent TAVR at 10 centers from May 2007 to October 2014. Half of the patients were men and the mean age was 80 years. Eligible participants had undergone a minimum of two post-TAVR echocardiograms, at discharge and at a minimum at 6- to 12-month follow-up. The researchers acquired clinical, procedural and echocardiographic data from a TAVR database at each participating center. Transthoracic echocardiography examinations were performed at baseline, hospital discharge, at 6 to 12 months after TAVR and annually thereafter.
The researchers found a decrease in average mean transaortic gradient, from 45.9 ± 16.1 mm Hg at baseline to 9.96 ± 5.37 mm Hg at discharge. From discharge to follow-up, the overall absolute change in transprosthetic gradient was 0.59 ± 5.5 mm Hg (P < .001), and the yearly annualized gradient change was 0.3 ± 4.99 mm Hg/year.
Univariable and multivariable analyses revealed the following variables as independently associated with increased rates of transprosthetic gradient progression over time: anticoagulation treatment ( P= .009), a valve-in-valve procedure (P = .036) and the use of a 23-mm or smaller transcatheter valve (\ P = .012). The following factors were identified as independent predictors of valve hemodynamic deterioration: absence of anticoagulation at discharge (P = .002), valve-in-valve procedure (P = .032); use of a 23-mm or smaller valve (P = .016) and a higher BMI (P = .001).
“Patients who have undergone TAVR are prone to progressively increasing transvalvular pressure gradients over time. Factors associated with hemodynamic deterioration include greater BMI, smaller valve diameter, a valve-in-valve procedure and lack of anticoagulation,” researchers wrote. “Future studies should quantify the impact of early hemodynamic deterioration and compare the effects of different antithrombotic regimens on long-term clinical outcomes after TAVR.” – by Jennifer Byrne
Disclosure: One researcher is a proctor for Medtronic; a second researcher reports core laboratory contracts with Edwards Lifesciences for which he receives no direct compensation; and a third researcher reports receiving research grants from Edwards Lifesciences, Medtronic and St. Jude Medical. The other researchers report no relevant financial disclosures.