Supra-annular transcatheter aortic valves yielded significantly lower maximum (14 vs 16 mmHg) and mean (8 vs 9 mmHg) aortic gradients compared to intra-annular valves.
Do different transcatheter aortic valve systems (expansion mechanisms and leaflet positions) result in different early echocardiographic hemodynamic changes in patients with severe aortic stenosis?
Supra-annular transcatheter heart valves are associated with lower early post-procedural transaortic gradients compared to intra-annular valves, though perivalvular leak rates are comparable.
Background: Transcatheter aortic valve implantation (TAVI) is a viable alternative therapeutic approach for patients with severe aortic stenosis (AS), following technological innovations in transcatheter aortic valve systems and advances in clinical expertise, which aim to optimize valve hemodynamics. In this study, we aimed to compare early hemodynamic changes in different types of TAVI valves via two-dimensional echocardiography. Methods: This retrospective observational study examined patients with severe AS who underwent transfemoral TAVI. Patients were classified according to expansion mechanism (self-expanding valves (SEVs) or balloon-expandable valves (BEVs)) and leaflet position relative to the annulus (supra-annular valves (SAVs) or intra-annular valves (IAVs)). The implanted prostheses were Edwards SAPIEN XT valves (ESV, Edwards Lifesciences, Irvine, CA, USA), Medtronic valves (Core Valve-MCV and Evolut R, Medtronic, Minneapolis, MN, USA), Portico valves (St. Jude Medical, Saint Paul, MN, USA), and Myval valves (Meril Life Sciences, Vapi, India). Baseline two-dimensional transthoracic echocardiography (TTE) datasets were compared with post-TAVI measures obtained before discharge. Results: In total (n = 332), 275 (82.8%) patients were treated with SEVs, and 57 (17.2%) were treated with BEVs. In terms of leaflet position, 249 (75%) patients were treated with SAVs, and the remaining 83 (25%) patients were treated with IAVs. Transaortic gradients were comparable between patients treated with SEVs and BEVs. However, patients treated with IAVs exhibited significantly higher aortic maximum gradients (16 13–21 mmHg vs. 14 10–20 mmHg, p = 0.019) and mean gradients (9 7–11 mmHg vs. 8 5–10 mmHg, p = 0.014) compared to those receiving SAVs. Post-TAVI gradients were also compared based on each TAVI device. Although post-TAVI aortic maximum gradient was comparable among TAVI devices (p = 0.080), aortic mean gradient was significantly different among the valves (p = 0.006). Post hoc analyses demonstrated that the post-TAVI mean gradient was significantly lower in Medtronic CoreValve compared to the Myval (p = 0.013) and Portico (p = 0.030). No significant differences were observed in the frequency of perivalvular leak between the valve groups. Conclusions: We found that post-TAVI transaortic gradients of SEVs and BEVs were comparable; however, SAVs were associated with lower transaortic gradients than those of the IAVs. In addition, the frequency of ≥moderate PVL was comparable between the valve groups.
Dursun et al. (2026) studied this question. Supra-annular transcatheter aortic valves yielded significantly lower maximum (14 vs 16 mmHg) and mean (8 vs 9 mmHg) aortic gradients compared to intra-annular valves.