Hemodynamic structural valve deterioration following transcatheter aortic valve implantation with latest-generation balloon-expandable valves.

Aims: Elevated gradients have been proposed to be associated with haemodynamic structural valve deterioration (SVD) after transcatheter aortic valve implantation (TAVI); however, data regarding their characterisation remain scarce. This study sought to investigate the prevalence and predictors of moderate or greater SVD and the prevalence of valve thrombosis during follow-up after TAVI with balloon-expandable valves. Methods and results: A total of 691 patients undergoing transfemoral TAVI were enrolled. The primary endpoint was moderate or severe haemodynamic SVD during 12-month follow-up after TAVI, defined as (I) mean transvalvular gradient >= 20 mmHg or (II) mean transvalvular gradient increase >= 10 mmHg. The primary endpoint was observed in 10.3% after TAVI. Use of a 20 mm valve, valve-in-valve procedure and oral anticoagulation (OAC) were independently associated with haemodynamic SVD, whereas valve-in-valve procedure and OAC were the only significant variables after accounting for death as a competing event. OAC was significantly associated with haemodynamic SVD (RR 8.65; p=0.004) and death (RR 3.57; p=0.06), whereas valve-in-valve procedure was only associated with haemodynamic SVD (RR 52.76; p<0.001). Valve thrombosis was present in 0.87% (6/691) of the patients. Conclusions: The prevalence of moderate or greater haemodynamic SVD during the first 12 months after TAVI is 10.3%. Procedural factors and pharmacotherapy seem to play a key role during manifestation. Future studies should focus on the underlying mechanisms.