Valvular & structural heart disease
Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves
Authors' conclusion
Discharge MG <10 mm Hg is associated with lower ejection fraction and increased 5-year mortality following aortic valve-in-valve replacement compared with higher MG in a nonlinear fashion. Severe PPM and MG > 20 mm Hg were not associated with worse 5-year clinical outcomes. Incorporating data on ejection fraction with PPM and MG is important before determining the need for valve optimization.
Study context
- Population
- Patients who underwent aortic valve-in-valve replacement with a balloon-expandable valve from July 2015 to December 2023patients included
- Participants
- 13,054 patients
- Exposure
- Discharge MG <10 mm Hg vs MG ≥10 mm Hg; severe patient prosthesis mismatch (PPM) vs none/moderate PPM; MG ≥20 mm Hg vs MG ≤20 mm Hg
- Outcome
- Relationship between discharge MG and 5-year mortality (spline curves)
- Follow-up
- 5 years
Methodological detailsSociety of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, adjusted Cox models with regression splines
- Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry
- Adjusted Cox models with regression splines
Main finding
As reported in the abstract
- Nonlinear relationship between discharge MG and 5-year mortality
Observational data: associations, not effects.
Further findings
| Outcome | Hazard ratio (95% CI) | P value | |
|---|---|---|---|
| 5-year mortality · higher 5-year mortality with MG <10 mm Hg | 1.15 (1.02–1.29) | P = 0.024 | |
| 0.512Hazard ratio (log scale) |
| Outcome | MG <10 mm Hg | MG ≥10 mm Hg | P value |
|---|---|---|---|
| Ejection fractionLower ejection fraction with MG <10 mm Hg | 50.4 ± 13.9 | 53.2 ± 12.8 | P < 0.0001 |
5-year outcomes by severe PPM and MG ≥20 mm Hg
- Severe PPM and MG ≥20 mm Hg were not associated with worse 5-year outcomes compared with none/moderate PPM or MG ≤20 mm Hg, respectively
Original publication
Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves. Circ Cardiovasc Interv. Published 9 February 2026. doi:10.
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