Impact of Pressure Recovery Adjustment on Aortic Valve Area Classification of Disease Severity in Transcatheter Aortic Valve Replacement Patients

Objectives To determine the impact of pressure recovery (PR) adjustment on disease severity grading in patients with severe aortic stenosis. We hypothesize that accounting for PR will result in echocardiographic reclassification of aortic stenosis severity in a significant number of patients. Design Retrospective Observational study between October 2013 and February 2021. Setting Single center, quaternary care academic center. Participants Adults (≥ 18 years old) who underwent transcatheter aortic valve implantation (TAVI) Interventions Transcatheter aortic valve implantation Measurements A total of 342 patients were evaluated in this study. LV mass index was significantly greater in patients who continued to be severe after PR (100.47 ± 28.77 vs 90.15 ± 24.03, p = <0.000001). Using PR adjusted aortic valve area (AVA) resulted in the reclassification of 81 patients (24%) from severe to moderate aortic stenosis (AVA >1.0 cm2). Of the 81 patients who were reclassified, 23 patients (28%) had sino-tubular junction (STJ) diameters >3.0 cm. Conclusion Adjusting calculated AVA for PR resulted in a reclassification of a significant number of adult patients from severe to moderate aortic stenosis. PR was significantly larger in patients who reclassified from severe to moderate aortic stenosis after adjusting for PR. PR appears to remain relevant in patients with STJ ≥ 3.0 cm. Clinicians need to be aware of PR and how to account for its effect when measuring pressure gradients with Doppler.