What question did this study set out to answer?

To assess the incidence, timing, and independent predictors of valve hemodynamic deterioration (VHD) following transcatheter aortic valve replacement (TAVR).

August 15, 2026Journal of the American College of CardiologyOpen Access

Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Transcatheter aortic valve replacement (TAVR) (n=1521). Intervention: Absence of anticoagulation therapy at discharge vs. Anticoagulation therapy at discharge. Primary outcome: Valve hemodynamic deterioration (VHD) (HR 3.35, 95% CI 1.57-7.13, p=0.002).

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Why the study?

Data were scarce regarding the incidence of and factors associated with valve hemodynamic deterioration after TAVR.

Population

1,521 patients undergoing TAVR

Comparison

Predictors and incidence of valve hemodynamic deterioration

Design

Multicenter registry

Follow-up

Mean 20 ± 13 months

Key result

The absence of anticoagulation therapy at discharge was associated with a significantly increased risk of valve hemodynamic deterioration after transcatheter aortic valve replacement (HR 3.35).

Authors

MTMaría Del Trigo AMAntonio J. Muñoz-García HWHarindra C. Wijeysundera

Discussion

Member takes

Overview

Should not yet change antithrombotic practice after TAVR; leaves open whether anticoagulation prevents hemodynamic deterioration.

Key Points

To assess the incidence, timing, and independent predictors of valve hemodynamic deterioration (VHD) following transcatheter aortic valve replacement (TAVR).
Analyzed data from a multicenter registry of 1,521 patients (48% male; mean age 80 ± 7 years) who underwent TAVR.
Conducted echocardiographic evaluations at discharge, at 6 to 12 months, and annually thereafter, over a mean follow-up of 20 ± 13 months (minimum 6 months).
Defined VHD as a transprosthetic mean gradient increase of ≥10 mm Hg from hospital discharge baseline.
Valve hemodynamic deterioration occurred in 68 patients (4.5% overall incidence), with a mean annualized transprosthetic gradient increase of 0.30 ± 4.99 mm Hg/year across the cohort.
Independent predictors of VHD included absence of anticoagulation therapy at discharge (p = 0.002), valve-in-valve procedures (p = 0.032), 23-mm valve prosthesis use (p = 0.016), and elevated body mass index (p = 0.001).

Study Design

Type

Cohort (n=1,521)

Multicenter

Yes

Structured PICO

Population

1,521 patients (mean age 80 years, 52% female) who underwent transcatheter aortic valve replacement and had at least two post-procedure echocardiograms, followed for a mean of 20 months.

Exposure

Transcatheter aortic valve replacement (TAVR)

Outcome

Valve hemodynamic deterioration (VHD), defined as a ≥10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessmentsurrogate

Main Result

Hazard Ratio: 3.35 (95% CI 1.57–7.13)

Absolute Event Rate: 5.6% vs 1.9%

p-value: p=0.002

Valve hemodynamic deterioration occurs in approximately 4.5% of patients after TAVR and is independently predicted by the absence of anticoagulation, valve-in-valve procedures, smaller valve size, and higher body mass index.

Limitations

Retrospective analysis of prospectively collected data
Exclusion of patients who died within 6 months post-TAVR may underestimate actual VHD incidence
No independent echocardiographic core laboratory analysis
Missing effective orifice area (EOA) measures in a significant number of patients
No systematic transesophageal echocardiography or CT studies to seek the underlying process of VHD

Cite This Study

Trigo et al. (2016) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=1,521). Absence of anticoagulation therapy at discharge vs. Anticoagulation therapy at discharge was evaluated on Valve hemodynamic deterioration (VHD) (HR 3.35, 95% CI 1.57-7.13, p=0.002). The absence of anticoagulation therapy at discharge was associated with a significantly increased risk of valve hemodynamic deterioration after transcatheter aortic valve replacement (HR 3.35).

synapsesocial.com/papers/6a80509890df07fd7ab3b506 https://doi.org/10.1016/j.jacc.2015.10.097

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August 15, 2026Journal of the American College of CardiologyOpen Access

Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement

View Full Paper

Ask AI

Bookmark

Why the study?

Data were scarce regarding the incidence of and factors associated with valve hemodynamic deterioration after TAVR.

Population

1,521 patients undergoing TAVR

Comparison

Predictors and incidence of valve hemodynamic deterioration

Design

Multicenter registry

Follow-up

Mean 20 ± 13 months

Key result

The absence of anticoagulation therapy at discharge was associated with a significantly increased risk of valve hemodynamic deterioration after transcatheter aortic valve replacement (HR 3.35).

Authors

MTMaría Del Trigo AMAntonio J. Muñoz-García HWHarindra C. Wijeysundera

Discussion

Member takes

Overview

Should not yet change antithrombotic practice after TAVR; leaves open whether anticoagulation prevents hemodynamic deterioration.

Key Points

To assess the incidence, timing, and independent predictors of valve hemodynamic deterioration (VHD) following transcatheter aortic valve replacement (TAVR).
Analyzed data from a multicenter registry of 1,521 patients (48% male; mean age 80 ± 7 years) who underwent TAVR.
Conducted echocardiographic evaluations at discharge, at 6 to 12 months, and annually thereafter, over a mean follow-up of 20 ± 13 months (minimum 6 months).
Defined VHD as a transprosthetic mean gradient increase of ≥10 mm Hg from hospital discharge baseline.
Valve hemodynamic deterioration occurred in 68 patients (4.5% overall incidence), with a mean annualized transprosthetic gradient increase of 0.30 ± 4.99 mm Hg/year across the cohort.
Independent predictors of VHD included absence of anticoagulation therapy at discharge (p = 0.002), valve-in-valve procedures (p = 0.032), 23-mm valve prosthesis use (p = 0.016), and elevated body mass index (p = 0.001).

Study Design

Type

Cohort (n=1,521)

Multicenter

Yes

Structured PICO

Population

1,521 patients (mean age 80 years, 52% female) who underwent transcatheter aortic valve replacement and had at least two post-procedure echocardiograms, followed for a mean of 20 months.

Exposure

Transcatheter aortic valve replacement (TAVR)

Outcome

Valve hemodynamic deterioration (VHD), defined as a ≥10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessmentsurrogate

Main Result

Hazard Ratio: 3.35 (95% CI 1.57–7.13)

Absolute Event Rate: 5.6% vs 1.9%

p-value: p=0.002

Limitations

Retrospective analysis of prospectively collected data
Exclusion of patients who died within 6 months post-TAVR may underestimate actual VHD incidence
No independent echocardiographic core laboratory analysis
Missing effective orifice area (EOA) measures in a significant number of patients
No systematic transesophageal echocardiography or CT studies to seek the underlying process of VHD

Cite This Study

synapsesocial.com/papers/6a80509890df07fd7ab3b506 https://doi.org/10.1016/j.jacc.2015.10.097

Also Consider

Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context:

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