Hemodynamic principles of prosthetic aortic valve evaluation in the transcatheter aortic valve replacement era

Abbas, Amr E.; Mando, Ramy; Hanzel, George; Goldstein, James A.; Shannon, Francis

doi:10.1111/echo.14663

Cited by 25 publications

(25 citation statements)

References 61 publications

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“…Discordance between echocardiography and catheterization in the assessment of transvalvular mean gradient has been reported in native aortic stenosis (AS), following SAVR, TAVR, and ViV-TAVR. 2 Echocardiography overestimates the invasive mean gradients, and previous studies have suggested that following SAVR, this discordance is related to valve design [3][4][5][6] and degree of prosthesis obstruction, 7 and it is independent of the aortic dimension and the phenomenon of pressure recovery. 2 The relationship between echocardiography and catheterization mean gradients has not been investigated in patients with degenerate bioprosthetic valves.…”

Section: See Commentary On Page 61mentioning

confidence: 95%

“…2 Echocardiography overestimates the invasive mean gradients, and previous studies have suggested that following SAVR, this discordance is related to valve design [3][4][5][6] and degree of prosthesis obstruction, 7 and it is independent of the aortic dimension and the phenomenon of pressure recovery. 2 The relationship between echocardiography and catheterization mean gradients has not been investigated in patients with degenerate bioprosthetic valves. We sought to compare echocardiographic and invasive mean gradients in patients with failed surgical bioprosthesis.…”

Section: See Commentary On Page 61mentioning

confidence: 95%

“…Echocardiographic and invasive mean gradient absolute discordance was observed in 41 patients with MAVD (12 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] mm Hg, median invasive 19 mm Hg [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] vs echocardiographic mean gradient 31 mm Hg [23-39]; P<.0001) as well as in 9 patients with bioprosthetic AR (7 [5-12] mm Hg, median invasive 3 mm Hg [1][2][3][4][5][6] vs echocardiographic mean gradient 12 mm Hg [7-22]; P ¼ .017). However, in 24 patients with bioprosthetic AS (4 [-10 to 19] mm Hg, median invasive 35 mm Hg [24-45] vs echocardiographic mean-gradient 41 mm Hg [30-50]; P ¼ .45), no discordance was observed (Figure 2, B).…”

Section: Analysis According To Mechanism Of Failurementioning

confidence: 99%

“…14 Discordance between echocardiographic and invasive gradient has been reported in native severe AS and in prosthetic valves. 2 Following SAVR, echocardiography overestimates the invasive mean gradient and this is related to the degree of prosthesis stenosis, 7 valve design and flow pattern, [3][4][5][6] and is independent of ascending aortic area and hence not just a phenomenon of pressure recovery. 2 This has been also described following TAVR and ViV-TAVR 15 and occurs due to several reasons.…”

Section: Discordance Between Echocardiography and Invasive Mean Gradientsmentioning

confidence: 99%

“…Echocardiography-catheterization mean gradient discordance was observed in all patients (invasive ¼ 22 mm Hg vs echocardiographic ¼ 32 mm Hg [21-42], P ¼ .013), small valves (invasive ¼ 15 mm Hg vs echocardiographic ¼ 28 mm Hg [21-41], P ¼ .013), and large valves (invasive ¼ 20 mm Hg [8.5-27.13] vs echocardiographic ¼ 32 mm Hg [25.5̶ 41.5], P < .0001), with a bias of 8 AE 15 mm Hg and wide limits of agreement (-22 to 39 mm Hg) on Bland-Altman plots, indicating these modalities may not be interchangeable. Discordance occurred in AR (invasive ¼ 3 mm Hg [1][2][3][4][5][6] Conclusions: Discordance between echocardiography and invasive mean gradients exists in degenerated SAVR, regardless of valve size, but depends on mechanism of failure and DI helps stratify these patients. With a discrepancy between echocardiographic mean gradients AND the patient's symptoms OR the valve leaflet structure and/or mobility on imaging, especially before redo-SAVR or valve-in-valve transcatheter aortic valve replacement, invasive gradients may adjudicate the true valvular hemodynamics.…”

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confidence: 95%

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Invasive versus echocardiographic gradients in degenerated surgical aortic valve prostheses: A multicenter study

et al. 2021

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Objectives: To compare echocardiographic and invasive mean gradients obtained concomitantly in degenerated bioprosthetic surgical aortic valves (SAVRs).Methods: In a multicenter study, we compared concomitant echocardiographic and invasive mean gradients of SAVR, obtained before valve-in-valve transcatheter aortic valve replacement in all patients, patients with primary stenosis (AS), primary aortic regurgitation (AR), and mixed aortic valve disease (MAVD), and in small versus large valves ( or >23 mm). Dimensionless index (DI) was calculated in all groups.

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Section: See Commentary On Page 61mentioning

confidence: 95%

Section: See Commentary On Page 61mentioning

confidence: 95%

Section: Analysis According To Mechanism Of Failurementioning

confidence: 99%

Section: Discordance Between Echocardiography and Invasive Mean Gradientsmentioning

confidence: 99%

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Invasive versus echocardiographic gradients in degenerated surgical aortic valve prostheses: A multicenter study

et al. 2021

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Real world outcomes using 20 mm balloon expandable SAPIEN 3/ultra valves compared to larger valves (23, 26, and 29 mm)–a propensity matched analysis

Eng

Abbas

Hahn

et al. 2021

Cathet Cardio Intervent

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Objective/Background: Small balloon expandable valves have higher echocardiographic transvalvular gradients and rates of prosthesis-patient mismatch (PPM) compared to larger valves. However, the impact of these echocardiographic findings on clinical outcomes is unknown. We sought to determine the clinical outcomes of 20 mm SAPIEN 3 (S3 BEV) compared to larger S3 BEV in relation to echocardiographic hemodynamics.Methods: Using the STS/ACC transcatheter valve registry, we performed a propensity-matched comparison of patients undergoing treatment of native aortic valve stenosis using transfemoral, balloon-expandable implantation of 20 mm and ≥ 23 mm S3 BEVs. Baseline and procedure characteristics, echocardiographic variables and survival were analyzed. Multivariable logistic regression was used to identify predictors of 1-year mortality.Results: After propensity matching of the 20 mm and ≥ 23 mm SAPIEN 3 valves, 3,931 pairs with comparable baseline characteristics were identified. Small valves were associated with significantly higher echocardiographic gradients at discharge (15.7 ± 7.1 mmHg vs. 11.7 ± 5.5 mmHg, p < 0.0001) and severe PPM rates (21.5% vs. 9.7%, p < 0.0001). There was no significant difference in 1-year all-cause mortality (20 mm: 13.0% vs. ≥23 mm: 12.7%, p = 0.72) or other major adverse event rates and outcomes between the two cohorts. Based on a multivariable analysis, elevated discharge mean gradient (>20 mmHg), severe PPM and the use of 20 mm versus ≥23 mm were not independent predictors of 1-year mortality.Conclusion: SAPIEN 3 20 mm valves were associated with higher echocardiographic gradients, and severe PPM rates compared to larger valves but these factors were not associated with significant differences in 1-year all-cause mortality or rehospitalization. K E Y W O R D S structural heart disease, transcatheter aortic valve replacement, TVT registry Statistical analyses were performed by Edwards Lifesciences. The views or opinions presented here do not represent those of the American College of Cardiology, the Society of Thoracic Surgeons, or the STS/ACC TVT Registry.

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In vitro Doppler versus catheter transvalvular pressure gradients in balloon‐expandable versus self‐expanding transcatheter aortic valves

Stanová

Rieu

Côté

et al. 2021

Cathet Cardio Intervent

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Objectives The objective of this in vitro study was to compare Doppler versus catheter transvalvular pressure gradients (TPG) in third generations balloon‐expandable (BE) versus self‐expanding (SE) transcatheter heart valves (THV). Background TPG is a key parameter to assess and follow valve hemodynamic function following transcatheter aortic valve implantation (TAVI). It remains uncertain and debated whether, and to which extent, TPGs differ according to the type of THV, that is, BE versus SE and to the method used for TPG measurement, that is, Doppler echocardiography versus cardiac catheterization. Methods The CoreValve EVOLUT PRO 26 mm and the SAPIEN 3 23 mm THVs were tested in a left heart simulator using a 21 mm aortic annulus under following conditions: heart rate: 70 bpm, mean aortic pressure: 100 mmHg, stroke volume: 30, 70 and 100 ml. Mean TPGs were measured by continuous‐wave Doppler and by micro‐tip pressure catheters positioned in the left ventricle and at 50 mm downstream to the tip of the THV leaflets. Results Doppler TPGs (9.5 ± 3.9 mmHg) were on average 40.5 ± 13.9% higher (p < 0.001) than catheter TPGs (6.3 ± 3.4 mmHg). Both Doppler and catheter TPGs were lower (p = 0.003) in the SE versus BE THVs (Doppler: 8.7 ± 3.5 vs. 10.7 ± 4.6; catheter: 5.0 ± 1.7 mmHg vs. 7.1 ± 2.2). The Doppler versus catheter difference in TPG increased with the higher flow conditions. The Doppler versus catheter difference in TPG was similar in BE versus SE THVs (3.6 ± 1.1 vs. 3.7 ± 1.4 mmHg or 42 ± 9 vs. 47 ± 9%; p = 0.58) overall and in each flow conditions. Conclusion The Doppler TPGs are, on average, 40% higher than the catheter TPGs for both BE and SE THVs. The SE THV had lower Doppler and catheter TPGs compared to the BE THV, at normal and high flow states. The absolute and percent differences between Doppler versus catheter TPGs were similar in BE versus SE THVs.

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Hemodynamic principles of prosthetic aortic valve evaluation in the transcatheter aortic valve replacement era

Cited by 25 publications

References 61 publications

Invasive versus echocardiographic gradients in degenerated surgical aortic valve prostheses: A multicenter study

Invasive versus echocardiographic gradients in degenerated surgical aortic valve prostheses: A multicenter study

Real world outcomes using 20 mm balloon expandable SAPIEN 3/ultra valves compared to larger valves (23, 26, and 29 mm)–a propensity matched analysis

In vitro Doppler versus catheter transvalvular pressure gradients in balloon‐expandable versus self‐expanding transcatheter aortic valves

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