Valvular & structural heart diseaseCohort study
Real-Time Fluoroscopic Assessment of Underexpansion Predicts Hemodynamic Valve Deterioration Following Transcatheter Aortic Valve Replacement (TAVR) With Balloon-Expandable Device
- Retrospective cohort study
- prospective registry, retrospectively evaluated
- single-centre
Authors' conclusion
Underexpansion of balloon-expandable THVs is associated with an increased risk for HVD at mid-term follow-up.
Study context
- Population
- Consecutive patients undergoing transfemoral TAVR with SAPIEN 3 or SAPIEN 3 Ultra (Bern TAVI registry), 2014–2022
- Participants
- 1,043 patients
- Exposure
- Transcatheter heart valve (THV) underexpansion ≥20% vs no significant underexpansion
- Underexpansion ≥20%n = 57
- Outcome
- Moderate or severe hemodynamic valve deterioration (HVD, VARC-3); all-cause and CV mortality
- Follow-up
- 5-year follow-up
Main finding
As reported in the abstract
Moderate or severe HVD
Subdistribution hazard ratio (95% CI)
Underexpansion ≥20% vs No significant underexpansion
4.88(2.18–10.97)
Underexpansion ≥20%per 5% increase in underexpansion; consistent across all valve sizes
1.94(1.42–2.79)
Observational data: associations, not effects.
Further findings
Mortality · 862-day follow-up (Q1-Q3: 366-1,812 days)
- Underexpansion not associated with mortality
Predictors of THV underexpansion
- Total aortic valve calcium volume, bicuspid anatomy and valve iteration were significant predictors
Original publication
Real-Time Fluoroscopic Assessment of Underexpansion Predicts Hemodynamic Valve Deterioration Following TAVR With Balloon-Expandable Device. JACC Cardiovasc Interv. Published 14 November 2025. doi:10.1016/j.jcin.2025.10.005
Summarised from the published abstract; every number is checked against it