Hemodynamic deterioration 1 year after TAVR found in 6% of patients
Signs of early hemodynamic valve deterioration (HVD) are present in approximately 6% of transcatheter aortic valve replacement (TAVR) patients after one year, according to a new single-center analysis published in The Annals of Thoracic Surgery.[1]
“HVD represents a broad set of clinical scenarios in which valvular performance is impaired secondary to changes in flow dynamics across the valve,” wrote lead author Eishan Ashwat, BS, a medical student at the University of Pittsburgh School of Medicine, and colleagues. “Whereas structural valve deterioration (SVD) is a pathologic diagnosis involving physical damage to the valve's structure, HVD is a functional diagnosis based on valvular performance under hemodynamic stress and may often be the result of insulting SVD, patient-prosthesis mismatch or subclinical thrombosis. Therefore, HVD, particularly stage 2 or greater as defined by VARC-3 guidelines, serves as a valuable metric for detecting the onset or presence of bioprosthetic valve failure, a pathologic process that necessitates aortic valve reintervention.”
The study focused on more than 4,000 TAVR patients treated at a single facility from 2012 to 2022. Follow-up echo data from one year after TAVR were available for nearly 50% of all patients. Overall, signs of HVD—defined using Valve Academic Research Consortium 3 (VARC-3) definitions—were identified in 6.2% of those patients.
HVD after one year was more common in patients with a smaller aortic annulus. In fact, receiving a larger valve was linked to a “protective” quality that appeared to help keep the risk of HVD to a minimum.
One key takeaway from the study was the five-year cumulative incidence of aortic valve reintervention was significantly higher in patients with HVD after one year. Patients with HVD after one year were also linked to a higher likelihood of paravalvular leak.
However, HVD did not make a significant impact on postoperative outcomes or mortality estimates.
Data provides additional context as TAVR continues to gain momentum
This was a single-center analysis, and its design “may introduce considerable selection bias,” but the authors do point to these data as a reminder that researchers are still learning more about SVD, HVD and other post-TAVR outcomes.
“As TAVR is increasingly used in younger and healthier patients, our findings suggest a need to carefully consider valve sizing and long-term durability,” Ashwat said in a statement from The Society of Thoracic Surgeons. “Early identification of hemodynamic deterioration may serve as a key predictor of future reintervention and patient outcomes.”
Click here to read the full study.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.