Comparison of Catheterization Versus Echocardiographic Based Gradients in Balloon Expandable Versus Self Expanding TAVR
Presenter
Michael A Biersmith, MD, Hospital Corporation of America, Nashville, TN
Michael A Biersmith, MD1, Maurice Alston, D.O.2, Nader Makki, MD3, Hoda Hatoum, PhD4, Breandan A Yeats, BS5, David Orsinelli, M.D.6, Lakshmi Dasi, Ph.D.5, Konstantinos Dean Boudoulas, MD, FSCAI6 and Scott M. Lilly, M.D., Ph.D.7, (1)Hospital Corporation of America, Nashville, TN, (2)Parkridge Medical Center, Chattanooga, TN, (3)Pima Heart and Vascular, Tucson, AZ, (4)Michigan Technological University, Houghton, Michigan, MI, (5)Georgia Institute of Technology, Atlanta, GA, (6)The Ohio State University Wexner Medical Center, Columbus, OH, (7)The Ohio State University, Columbus, OH
Keywords: Imaging & Physiology, Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background
In patients undergoing TAVR, accurate assessment of prosthesis gradients is important to assess valve function and durability, which drives clinical decision making.
Methods
We retrospectively reviewed 507 patients that underwent TAVR and compared mean invasive gradients to those obtained by transthoracic Doppler echo.
Results
In the final analysis, 255 patients received Sapien and 210 patients received CoreValve prostheses. As shown in
Figure 1A-C, mean Sapien and CoreValve invasive gradients were significantly lower than Doppler gradients. Doppler Sapien gradients were significantly higher than Doppler CoreValve gradients. In a subgroup analysis of 2
nd generation skirted valves, 31 patients received a Sapien XT valve and 73 patients received either an Evolut Pro or Evolut R valve. Invasive mean gradients (Sapien XT 3.5 ± 4.1 mm Hg, CoreValve Evolut Pro/R 4.2 ± 4.8 mm Hg) were significantly lower than Doppler gradients (Sapien XT 9.8 ± 4.4 mm Hg, CoreValve Evolut Pro/R 8.6 ± 5.1 mm Hg, p <0.0001 for both comparisons). The effect of valve size (23 mm, 26 mm, and 29 mm) on gradients was also analyzed. Invasive gradients did not differ between Sapien and CoreValve prostheses, though were significantly lower than Doppler gradients for all sizes (p<0.001 for all comparisons).
Conclusions
Doppler gradients acquired after TAVR are higher than those obtained invasively and are more pronounced in SAPIEN than CoreValve prostheses. These differences persist in skirted and unskirted designs, and across valve sizes. These observations may reflect peri-procedural hemodynamic changes, differences between prosthetic flow acceleration, or pressure recovery.
