TCT CONNECT-91 Invasive Versus Echocardiographic Gradients Post Valve-in-Valve TAVR: A Multicenter Trial

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Journal of the American College of Cardiology


BACKGROUND A single-center experience of significant discordance of invasive versus echocardiographic gradient post–VIV-TAVR was previously reported. The current study sought to expand these findings to a multicenter experience. METHODS Consecutive patients who underwent VIV-TAVR in 3 institutions that had invasive and echocardiographic gradients obtained concomitantly post-implant were included. Invasive and echocardiographic MG were compared in all patients, according to surgical valve size (>23 mm vs. <23 mm), TAVR valve size (>26 mm vs. <26 mm for balloon-expandable valves [BEV] and >26 mm vs. <26 mm for self expanding valves [SEV]), and in BEV versus SEV valves. Continuous data are reported as mean (SD), categorical data as n (%); p < 0.05 was considered significant. RESULTS A total of 80 consecutive patients were included. Invasive AV MG was significantly lower than echocardiographic MG in all patients, in large and small surgical valves, in large and small TAVR valves, and in BEV and SEV. BEV and SEV generated similar echocardiographic and invasive gradients. Smaller TAVR and SAVR valves generated higher invasive gradients than larger valves, respectively. However, only smaller TAVR valves generate a higher echocardiographic gradient than larger TAVR valves, whereas small and large SAVR valves generated similar echocardiographic gradients, suggesting an additional influence of TAVR valve size on the echocardiographic gradient (Table).CONCLUSION This multicenter trial confirmed discordance between invasive and echocardiographic gradients that is related to both TAVR and SAVR valve sizes.




17 Supplement S

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