Relationship between Invasive and Echocardiographic Transvalvular Gradients after Transcatheter Aortic Valve Replacement

Abstract

Introduction: Lower transcatheter aortic valve replacement (TAVR) pressure gradients have been reported after implantation of self-expanding valves compared with balloon-expandable valves; however, there is a paucity of data on the relationship between invasively measured transvalvular pressure gradients and Doppler-derived measurements. Methods: From September 2013 to September 2018, patients with native aortic valve stenosis who had both intraoperative invasive and postoperative echocardiography transvalvular pressure gradients were included for analysis. We used parametric and nonparametric statistics to compare aortic gradients within and between groups. Results: Of 171 patients, 152 (88.9%) patients had TAVR with a balloon-expandable valve and 19 (11.1%) with a self-expanding valve. Among all patients, the invasive aortic gradient was 7.8 ± 3.2 mmHg and the Doppler-derived aortic gradient was 11.0 ± 4.5 mmHg (p \ 0.001). Among those who received a balloon-expandable valve, the invasive aortic gradient was 7.5 ± 3 mmHg and the Doppler aortic gradient was 11.4 ± 4.5 mmHg (p \ 0.001). In contrast, among patients who received a self-expanding valve, the invasive aortic gradient was 10.3 ± 3.4 mmHg and the Doppler aortic gradient was 8.5 ± 4.6 mmHg (p = 0.18). Conclusions: Balloon-expandable valves were associated with lower invasive measurements versus post-TAVR Doppler gradients, while results were inconclusive regarding self-expanding valves.

The Lower, The Better? Think Beyond the Gradient after Transcatheter Aortic Valve Replacement for Small Annulus

“…Furthermore, the discordance of trans-valvular gradients between Doppler-derived measurements and invasive measurements is described among different type of THV. Aalaei-Andabili et al 6) have demonstrated a significant difference between invasive measurement and Doppler-derived gradients (7.5±3 mmHg vs. 11.4±4.5 mmHg, p<0.001) after BE-THV implantation. In contrast, there was no significant difference by either measurement for SE-THV (invasive vs. Doppler-derived gradient: 10.3±3.4 mmHg vs. 8.5±4.6 mmHg, p=0.18).…”

Comparison of Post-Procedural and 30-day Post-Implantation Transcatheter Aortic Valve Replacement Gradients with and without pre-implantation Balloon Valvuloplasty: A Real-World Analysis of Early Results using a Novel Balloon Expandable Transcatheter Aortic Valve

“…Prior data have shown that Doppler-measured and invasive, directly measured gradients can significantly vary [3][4][5][6]. Pressure recovery phenomena and fluid hemodynamics have been implicated as explanations.…”