Key result
New-generation BEVs linked to ~15 percentage points less 1-month HALT compared to SEVs.
Why the study?
The incidence and hemodynamic impact of hypoattenuated leaflet thickening (HALT) in new-generation transcatheter heart valves have not been fully elucidated.
Does the implantation of new-generation balloon-expandable valves compared to self-expanding valves affect the incidence of hypoattenuated leaflet thickening (HALT) and mean transprosthetic pressure gradient at one month in patients undergoing TAVI?
Observational (n=212)
Does the implantation of new-generation balloon-expandable valves compared to self-expanding valves affect the incidence of hypoattenuated leaflet thickening (HALT) and mean transprosthetic pressure gradient at one month in patients undergoing TAVI?
In new-generation transcatheter heart valves, hypoattenuated leaflet thickening at one month is less frequent in balloon-expandable valves than in self-expanding valves, but significantly increases mean transprosthetic pressure gradients in smaller balloon-expandable valves.
Background/Introduction The incidence and hemodynamic impact of hypoattenuated leaflet thickening (HALT) in new-generation transcatheter heart valves (THVs) have not been fully elucidated. Purposes The purpose of this study is to investigate the hemodynamic impact of HALT. Methods We enrolled 306 cases of transcatheter aortic valve implantation (TAVI) performed between July 2023 and October 2025. Balloon-expandable valves (BEVs) included Sapien3 Ultra RESILIA, while self-expanding valves (SEVs) included Evolut FX, Evolut FX+, and Navitor. A total of 212 patients with both one-month follow-up computed tomography and echocardiography were analyzed. Results BEV and SEV were implanted in 106 patients each. The incidence of HALT was significantly lower in the BEV group compared with the SEV group (21% vs. 36%, p=0.01). In the SEV group, the presence of HALT did not significantly affect the mean transprosthetic pressure gradient (PG) (8.5 mmHg vs. 8.8 mmHg, p=0.65). In contrast, HALT was associated with a significantly higher mean PG in the BEV group (12.5 mmHg vs. 9.8 mmHg, p=0.02). Notably, this effect was evident only in patients receiving 20mm (25.7 mmHg vs. 14.8 mmHg, p=0.053) and 23mm BEVs (11.9 mmHg vs. 9.8mmHg, p=0.044). Conclusion Among new-generation THVs, HALT was less frequent in BEVs compared with SEVs. However, HALT at one month after TAVI was associated with an increased mean PG in BEVs, particularly in smaller THVs.
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Hattori et al. (2026) conducted an observational in Transcatheter aortic valve implantation (TAVI) (n=212). New-generation balloon-expandable valves (BEVs: Sapien3 Ultra RESILIA) vs. New-generation self-expanding valves (SEVs: Evolut FX, Evolut FX+, Navitor) was evaluated on Incidence of hypoattenuated leaflet thickening (HALT) at 1 month (p=0.01). New-generation BEVs had lower 1-month HALT than SEVs (21% vs 36%, p=0.01), though HALT increased mean pressure gradient in BEVs (12.5 vs 9.8 mmHg, p=0.02).
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