Immediate and Long-term Echocardiographic Outcomes
The mean preoperative pressure gradients were significantly elevated
(dPmean 41.3 ± 15.3 mmHg) as consequence of stenosis as
predominant mode of failure (n=68/77; 88.3%).
All patients with preoperative stenotic bioprosthesis experienced a
significant reduction of their transvalvular pressure gradients after
successful TAVR, as confirmed by predischarge transthoracic
echocardiography (dPmean 16.8 ± 7.1 mmHg;
p<0.01; Figure 2A ). This was independent from the
inner diameter of the degenerated valve (Figure 2B ).
Median postprocedural mean transvalvular pressure gradient was 18.0 mmHg
with an interquartile range from 12.0 to 23.5 mmHg. None of the patients
had a mean postprocedural pressure gradient above 40 mmHg
postoperatively. Initial device success according to VARC-2 criteria was
achieved in 62.3% (n=48/77) of the cases (Figure 3 ). The
overall low success-rate was driven by mean transvalvular pressure
gradients, exceeding 20mmHg in 37.7% (n=29/77) of the patients. Hereby,
patients with a true-ID equal or less 21mm had significant less primary
device success compared to patients with a larger true-ID (48.9%
[n=22/45] vs. 81.3% [n=26/32] p=0.0299). Residual paravalvular
leakage was infrequent (n=6/77;7.8%). None of the residual PVL were
larger than trace.
During further follow-up transvalvular pressure gradients steadily
increased and correspondingly the device success rate decreased
(Figure 2 and 3) . After 3-years, only 28.6% (n=22/77) of the
patients had persisting device success according to VARC-2 criteria.
Mean Vmax was 317 ± 76 cm/sec (Median 280 cm/sec) with a
dPmean averaging 26.0 ± 12.2 mmHg (Median 24 mmHg) after
three years of follow-up (Table 3; Figure 2A ). This observation
was particularly true for internal diameters less or equal 21mm – after
an initial significant reduction, the mean transvalvular gradients
remained significantly increased (Figure 2B ).
Additionally, the trend of steadily deteriorating hemodynamic
performance during follow-up was independently from the type of
prosthesis. Despite self-expandable prostheses having a significant
higher rate of initial device success compared to balloon-expandable
valves (69.2% vs. 56.3%; p=0.047), this observation turned after 3
years with balloon-expandable THV now having a significantly higher rate
of persisting device success (36.3% vs. 21.4%, p=0.041)
(Figure 3 ).