Invasive and Echocardiographic Mean Transvalvular Pressure Gradients of Different Transcatheter Aortic Valve Prostheses.

Background/

Objectives

This study aimed to assess the effectiveness and clinical relevance of intraprocedural invasive measurements-specifically intraprocedural mean pressure gradients (IC MPGs) and diastolic delta (DD)-in comparison with echocardiography for evaluating transcatheter heart valve (THV) performance across different prosthesis types. Particular attention was paid to comparing outcomes between balloon-expandable (BE) and self-expandable (SE) valves, with further stratification by aortic annulus size.

Methods

A retrospective analysis was performed on 926 patients who underwent transcatheter aortic valve replacements (TAVRs) between 2012 and 2021. Patients were categorized into BE (n = 301) and SE (n = 625) valve groups. Intraprocedural MPG was measured immediately before and after valve deployment. Postprocedural echocardiographic MPG (EC MPG) and the degree of aortic regurgitation were assessed within five days after implantation. Aortic annuli were classified as small (≤23 mm) or large (≥24 mm).

Results

After implantation, EC MPG was consistently higher than IC MPG, with only a weak correlation observed between the two modalities. SE valves were generally associated with lower EC MPG than BE valves. DD was higher in the BE group; however, no significant correlation was found between DD and echocardiographically assessed aortic regurgitation.

Conclusions

Intraprocedural invasive measurements offer a reliable and immediate assessment of prosthesis function during TAVR but tend to underestimate gradients compared to echocardiography. Newer SE valves show performance comparable to BE valves, particularly in small annuli, supporting their use in challenging anatomies. DD appears to lack a diagnostic value for postprocedural aortic regurgitation.