Key result
Baseline moderate-to-severe MR does not alter early post-TAVI transvalvular gradient increases.
Why the study?
The etiology of the increase in transvalvular mean gradient from immediate to 24 hours post-TAVI is unclear, and the effects of mitral regurgitation on this rise have not been evaluated.
Does baseline moderate-to-severe mitral regurgitation affect the increase in transvalvular mean gradients 24 hours after transcatheter aortic valve implantation in patients with severe aortic stenosis?
Cohort (n=378)
No
Does baseline moderate-to-severe mitral regurgitation affect the increase in transvalvular mean gradients 24 hours after transcatheter aortic valve implantation in patients with severe aortic stenosis?
Absolute Event Rate: 6% vs 6%
p-value: p=0.87
Baseline moderate-to-severe mitral regurgitation does not significantly influence the early 24-hour increase in transvalvular gradients following TAVI compared to no-to-mild MR.
Baseline moderate-to-severe MR does not affect early post-TAVI gradient rise; hypothesis-generating for MR-hemodynamic interactions, prospective confirmation required.
Background: Following transcatheter aortic valve implantation (TAVI), transvalvular mean gradient is known to increase from immediate to 24 h post-procedure. While anesthesia, rapid-pacing, and volume status are blamed, the true etiology is unclear. To our knowledge, no prior studies have evaluated the effects of mitral regurgitation (MR) on the rise in post-TAVI transvalvular mean gradient. Methods: A single-center, retrospective analysis of patients who underwent TAVI at our institution between 2011 to 2020 was performed (n = 378, males = 206). Patients were divided into two groups, no-to-mild MR (n = 327) and moderate-to-severe MR (n = 51) based on echocardiograms obtained prior to TAVI. Transvalvular gradients were compared between immediate and 24-h post-TAVI echocardiograms. Results: The average age of no-to-mild MR patients (77 years (interquartile range (IQR): 71 - 84)) was similar to moderate-to-severe MR patients (79 years (IQR: 76 - 85), p=0.13). Both groups had similar procedural blood pressures and peri-procedural medication use. The change in 24-h post-TAVI mean transvalvular gradient was +6 mm Hg (IQR: 3.7 - 9) in the moderate-to-severe MR group and +6 mm Hg (IQR: 3.4 - 9) in the no-to-mild MR group (P = 0.87). Conclusions: In this study, we evaluated the impact of preexisting MR on changes in transvalvular gradients following TAVI. We observed no statistically significant difference in 24-h post-TAVI gradient changes between patients with moderate-to-severe MR and those with no-to-mild MR. These findings suggest that baseline MR may not be a major determinant of early post-TAVI hemodynamics; however, further prospective studies are needed to confirm this observation.
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Fogelson et al. (2025) conducted a cohort in Severe aortic stenosis (n=378). Moderate-to-severe mitral regurgitation vs. No-to-mild mitral regurgitation was evaluated on Numerical change (delta) in mean transvalvular gradient from immediate to 24 h post-TAVI (p=0.87). Baseline moderate-to-severe mitral regurgitation did not significantly affect the 24-hour post-TAVI increase in mean transvalvular gradient compared to no-to-mild mitral regurgitation (+6 mm Hg vs +6 mm Hg, p=0.87).
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