B-47| Change in Transvalvular Pressure Gradient at Discharge and Association With Mortality Following TAVR: A Multi-Center Echocardiographic and Invasive Registry

Document Type

Article

Publication Date

5-1-2023

Publication Title

Journal of the Society for Cardiovascular Angiography & Interventions

Abstract

Background

It is well established that transvalvular echocardiographic gradient increases from immediate post transaortic valve replacement (TAVR) to discharge. However, the impact of this “delta” change on mortality is not known. We sought to evaluate the association of this “delta” gradient on mortality.

Methods

Patients enrolled in a multicenter TAVR registry with available post-TAVR and discharge mean gradient (MG) were included in this analysis. Cox models with restricted cubic splines were constructed to explore the relationship between delta gradient and 2-year all-cause mortality. Cox models were adjusted for baseline gradient and baseline covariates, and a separate model also adjusted for baseline stroke volume index (SVi). Delta gradient cut-off of 5 mmHg was selected based on spline analysis for adjusted Cox Proportional hazards model.

Results

In unadjusted and adjusted spline regression analyses, low delta change was associated with a reduced mortality (Figure). A delta gradient < 5 mmHg was associated with a higher adjusted 2-year mortality (adjusted hazard ratio 1.30, 95% confidence interval 1.11-1.53, p=0.001). Those with low delta gradient were older, had higher STS, and lower LVEF, SVi, BMI, and BSA. Relationship between delta-gradient and mortality was not significantly modified by TAVR type.

Conclusions

In this large retrospective analysis of patients undergoing TAVR, a change in in transvalvular echocardiographic gradient at discharge of < 5 mmHg was associated with higher adjusted 2-year all-cause mortality.

Volume

2

Issue

3

First Page

100769

DOI

10.1016/j.jscai.2023.100769

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