Key result
Lower baseline resting aortic valve mean gradient linked to higher 1-year mortality in TAVR patients.
Why the study?
Patients with severe aortic stenosis with very low resting aortic valve mean gradient are underrepresented in TAVR studies.
Does baseline resting aortic valve mean gradient predict 1-year mortality and quality of life in patients with severe aortic stenosis undergoing TAVR?
Cohort (n=80,429)
Yes
Does baseline resting aortic valve mean gradient predict 1-year mortality and quality of life in patients with severe aortic stenosis undergoing TAVR?
Hazard Ratio: 0.93 (95% CI 0.91–0.94)
Absolute Event Rate: 20.9% vs 9.3%
p-value: p=<0.001
In patients undergoing TAVR, lower baseline resting aortic valve mean gradient is a significant predictor of higher 1-year all-cause mortality, although quality of life improves across all gradient subgroups.
Background Patients with severe aortic stenosis with very low resting aortic valve mean gradient (MG) are underrepresented in transcatheter aortic valve replacement (TAVR) studies. We investigated the association of resting aortic valve MG with post‐TAVR outcomes in a large nationwide cohort. Methods We included patients from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry with a self‐expanding Evolut TAVR (until December 2022) and eligible for 1‐year follow‐up without prior balloon aortic valvuloplasty, TAVR, or surgical aortic valve replacement. Results Among 80 429 patients (mean age, 80.7±7.9; women, 53.9%; high/extreme surgery risk, 51.2%) stratified into 6 echocardiographic resting aortic valve MG groups (10–<20, 20–<25, 25–<30, 30–<35, 35–<40, ≥40 mmHg), 1 year, all‐cause mortality increased progressively across decreasing MG subgroups (from 9.3%, ≥40 mmHg to 20.9%, 10–<20 mmHg; P <0.001; 10.8% entire cohort), as did hospital readmission. Kansas City Cardiomyopathy Questionnaire scores increased progressively across increasing MG subgroups ( P <0.001 at all time points). The Valve Academic Research Consortium 3 Kansas City Cardiomyopathy Questionnaire ordinal outcome improved substantially/moderately for all subgroups (1 year ≥52% patients). After multiple imputation for missing covariate data, Cox regression adjusting for clinically relevant baseline factors demonstrated a significant association between baseline MG and 1‐year mortality (hazard ratio, 0.93 [95% CI, 0.91–0.94]; P <0.001). Conclusions Baseline aortic valve MG is an important predictor of 1‐year all‐cause mortality in patients with severe aortic stenosis undergoing TAVR. Most patients undergoing TAVR had considerably improved quality‐of‐life assessments regardless of resting MG. Additional studies should elucidate mechanisms associated with MG–mortality risk and whether improved patient selection can further improve outcomes.
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Czarny et al. (2026) conducted a cohort in Severe aortic stenosis (n=80,429). Resting aortic valve mean gradient (MG) vs. Higher vs lower MG subgroups was evaluated on 1-year all-cause mortality (HR 0.93, 95% CI 0.91-0.94, p=<0.001). Lower baseline resting aortic valve mean gradient was associated with increased 1-year all-cause mortality (HR 0.93; 95% CI 0.91-0.94; P<0.001) in patients with severe aortic stenosis undergoing TAVR.
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