Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves.

BACKGROUND Lower (<10 mm Hg) discharge echocardiographic mean gradients (MGs) following transcatheter aortic valve replacement with balloon-expandable valves are associated with lower ejection fraction and higher 5-year mortality compared with higher gradients. Using the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, we studied the relationship between echocardiographic MG and patient prosthesis mismatch (PPM) following transcatheter aortic valve-in-valve replacement and clinical outcomes. METHODS Patients who underwent aortic valve-in-valve replacement with a balloon-expandable valve from July 2015 to December 2023 in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were included. Adjusted Cox models with regression splines explored the relationship between MG and 5-year mortality. Kaplan-Meier estimates and adjusted hazard ratios compared the occurrence of 5-year mortality between gradient cutoffs and PPM presence. RESULTS A total of 13 054 patients were included; spline curves demonstrated a nonlinear relationship between discharge MG and 5-year mortality. Kaplan-Meier curves suggested higher 5-year mortality with MG <10 mm Hg compared with MG ≥10 mm Hg (hazard ratio, 1.15 [95% CI, 1.02-1.29]; P=0.024). MG <10 mm Hg was associated with lower ejection fraction compared with higher MG (50.4±13.9 versus 53.2±12.8; P<0.0001). Severe PPM and MG ≥20 mm Hg were not associated with worse 5-year outcomes compared with none/moderate PPM or MG ≤20 mm Hg, respectively. CONCLUSIONS Discharge MG <10 mm Hg are associated with lower ejection fraction and increased 5-year mortality following aortic valve-in-valve replacement compared with higher MG in a nonlinear fashion. Incorporating data on ejection fraction with PPM and MG is important before determining the need for valve optimization.

• Publication year

  2026

• Venue

  Circulation. Cardiovascular Interventions

• Publication date

  2026-02-09

• Fields of study

  Medicine

• Identifiers
  DOI 10.1161/CIRCINTERVENTIONS.125.015945PMID 41657207PMCID PMC12991340
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

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