Valvular & structural heart disease
Asymmetrical Expansion of Balloon-Expandable Transcatheter Aortic Valve Prostheses: Implications for Valve Hemodynamic and Clinical Outcomes
Authors' conclusion
Asymmetrical expansion of balloon-expandable THVs was associated with impaired hemodynamic valve performance but not with clinical outcomes.
Study context
- Population
- Patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) for native severe AS with contemporary balloon-expandable transcatheter heart valves (THVs), February 2014 to June 2022
- Participants
- 1,216 patients
- Exposure
- TAVR asymmetry index
- Outcome
- Impaired hemodynamic valve performance (mean residual THV gradient ≥20 mm Hg and/or moderate or greater paravalvular regurgitation) on echocardiography
- Follow-up
- Before hospital discharge
Main finding
As reported in the abstract
Asymmetry index as predictor of impaired hemodynamic valve performance
AUC of asymmetry index
0.88
95% CI 0.84–0.92; P < 0.001
Optimal threshold
>5.5%
sensitivity 77%, specificity 86%
Patients above threshold
17%
Higher asymmetry index (continuous), adjusted OR
1.37
95% CI 1.29–1.46; P < 0.001
Observational data: associations, not effects.
Further findings
All-cause mortality, high TAVR asymmetry index · median 376 days of follow-up
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| High asymmetry index | 1.00 (0.71–1.41) | P = 0.989 | |
| 0.512Hazard ratio (log scale) |
Original publication
Asymmetrical Expansion of Balloon-Expandable Transcatheter Aortic Valve Prostheses: Implications for Valve Hemodynamic and Clinical Outcomes. JACC Cardiovasc Interv. Published 9 September 2024. doi:10.
Summarised from the published abstract; every number is checked against it