ArticleNetherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation2026
Invasive and echocardiographic gradients of self- and balloon-expandable valves in failing aortic bioprostheses.
Article in Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Study designs and outcomes.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026Article
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10 authors.
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Abstract
backgroundTranscatheter aortic valve implantation (TAVI) is an established treatment for a failing aortic bioprosthesis. The hemodynamics of TAVI in degenerated transcatheter or surgical aortic valves (TAV-in-TAV or TAV-in-SAV) are unknown. We aimed to investigate hemodynamic differences between self- and balloon-expandable TAV-in-TAV and TAV-in-SAV groups, and transthoracic echocardiography-derived (TTE) versus invasive transaortic pressure gradients.
methodsPatients ≥ 18 years with a self-expanding EVOLUT (SEV) or balloon-expandable SAPIEN3 (BEV) valve for TAV-in-TAV or TAV-in-SAV were included. Transaortic gradients were determined invasively and by TTE within 48 h post-intervention.
resultsWe identified 56 patients with SEV (n = 36) or BEV (n = 20) TAV in a failing aortic bioprosthesis. Fourteen cases involved failing transcatheter valves and 42 surgical bioprostheses. Invasive mean gradients were similar after BEV and SEV (median (25th-75th percentile): 6.0 (1.5-6.5) vs 7.0 (2.0-10.0) mm Hg, p = 0.109). Mean gradients by TTE were higher for BEV than SEV at discharge (16.0 (10.8-19.8) versus 10.0 (7.0-12.0) mm Hg, p = 0.003) and 12-month follow-up (13.0 (11.0-15.5) versus 9.0 (7.0-12.3) mm Hg, p = 0.025). The discrepancy between TTE and invasive mean gradients was significantly larger for BEV than SEV (13.0 (6.3-14.0) vs 3.0 (1.5-8.3) mm Hg, p = 0.001) and most pronounced in TAV-in-SAV (BEV 13.0 (6.3-17.0) vs SEV 3.0 (1.0-8.5) mm Hg, p = 0.004).
conclusionMean gradient after TAV in a failing bioprosthesis is similar for BEV and SEV, when measured invasively, but higher with BEV than SEV by TTE. The discordance between invasive and TTE-derived mean gradients is the largest in BEV.
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