Transmitral mean pressure gradient after transcatheter aortic valve replacement and late mortality

Abstract

Risk stratification after transcatheter aortic valve replacement (TAVR) focuses largely on aortic valve performance and baseline clinical characteristics. The prognostic relevance of residual transmitral haemodynamics after TAVR is uncertain. To assess whether post-TAVR transmitral mean pressure gradient (TMPG) and its periprocedural change (ΔTMPG) are associated with late mortality. Consecutive patients undergoing TAVR with paired pre- and post-procedural transthoracic echocardiography were analysed. Post-TAVR TMPG was measured on the first post-discharge study (1–6 months) and analysed both continuously and categorically (≥5 mmHg). ΔTMPG was defined as post- minus pre-TAVR TMPG. The primary endpoint was all-cause mortality during follow-up. Associations were evaluated using Cox proportional hazards models adjusted for predefined baseline clinical variables. Among 849 patients (median age 81 years; 47% women), over a median follow-up of 4.6 years, 322 deaths occurred. Higher post-TAVR TMPG was independently associated with late mortality (adjusted hazard ratio [HR] per 1 mmHg increase 1.13, 95% confidence interval [CI] 1.08–1.19; p<0.001). A TMPG ≥5 mmHg was associated with increased mortality (HR 1.87, 95% CI 1.43–2.44; p<0.001). Increasing ΔTMPG was also independently associated with mortality (HR per 1 mmHg increase 1.15, 95% CI 1.07–1.23; p<0.001). Residual transmitral haemodynamic burden after TAVR is independently associated with mortality and may inform post-procedural risk assessment.figure2figure1