Early Hemodynamic Valve Deterioration After Transcatheter Aortic Valve Implantation.

Abstract

This study aimed to elucidate the incidence, risk factors, and midterm outcomes associated with hemodynamic valve deterioration (HVD) 1 year after transcatheter aortic valve implantation (TAVI). This was a retrospective, single-institution cohort study of consecutive TAVIs from 2012 to 2022. Patients with immediate post-TAVI, 30-day, and 1-year echocardiographic data were included. HVD was defined per the Valve Academic Research Consortium 3 definition for stage 2 moderate HVD. The cohort was dichotomized by the presence or absence of HVD at 1-year follow-up. Clinical and echocardiographic outcomes were compared between groups. Multivariable logistic regression, Kaplan-Meier survival estimation, and Cox regression for mortality were performed. A total of 4317 patients underwent TAVI during the study period. Of those, 2123 had complete 1-year echocardiographic follow-up. Of these patients, 131 (6.2%) exhibited echocardiographic evidence of HVD 1 year after TAVI. One-year HVD patients were significantly younger and more likely to have smaller aortic annuli (23 mm vs 24 mm; P < .01) compared with non-HVD patients. On multivariable regression, larger implanted valve size was a protective factor against 1-year HVD (odds ratio, 0.88; 95% CI, 0.80-0.97; P < .01), whereas prior AVR was associated with higher risk of 1-year HVD (odds ratio, 2.15; 95% CI, 1.26-3.66; P < .01). Five-year cumulative incidence of aortic valve reintervention was significantly higher in HVD vs non-HVD patients (2.3% vs 0.6%, respectively). At 1-year follow-up, the incidence of HVD within the study cohort was 6.2%. Smaller implanted valve size was significantly associated with early HVD. Five-year cumulative incidence of aortic valve reintervention was significantly higher in HVD patients.