High post-procedural transvalvular gradient or delayed mean gradient increase after transcatheter aortic valve implantation: Incidence, prognosis and associated variables. the FRANCE-2 registry

Romain Didier, Clément Benic, Bahaa Nasr, Florent Le Ven, Sinda Hannachi, Hélène Eltchaninoff, Edward Koifman, Patrick Donzeau-Gouge, Jean Fajadet, Pascal Leprince, Alain Leguerrier, Michel Lièvre, Alain Prat, Emmanuel Teiger, Thierry Lefevre, Thomas Cuisset, Herve Le Breton, Vincent Auffret, Bernard Iung, Martine Gilard

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Mean Gradient (MG) elevation can be detected immediately after transcatheter aortic valve implantation (TAVI) or secondarily during follow-up. Comparisons and interactions between these two parameters and their impact on outcomes have not previously been investigated. This study aimed to identify incidence, influence on prognosis, and parameters associated with immediate high post-procedural mean transvalvular gradient (PPMG) and delayed mean gradient increase (6 to 12 months after TAVI, DMGI) in the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry. The registry includes all consecutive symptomatic patients with severe aortic stenosis who have undergone TAVI. Three groups were analyzed: (1) PPMG < 20 mmHg without DMGI > 10 mmHg (control); (2) PPMG < 20 mmHg with DMGI > 10 mmHg (Group 1); and (3) PPMG ≥ 20 mmHg (Group 2). From January 2010 to January 2012, 4201 consecutive patients were prospectively enrolled in the registry. Controls comprised 2078 patients. In Group 1(n = 131 patients), DMGI exceeded 10 mmHg in 5.6%, and was not associated with greater 4-years mortality than in controls (32.6% vs. 40.1%, p = 0.27). In Group 2 (n = 144 patients), PPMG was at least 20 mmHg in 6.1% and was associated with higher 4-year mortality (48.7% versus 40.1%, p = 0.005). A total of two-thirds of the patients with PPMG ≥ 20 mmHg had MG <20 mmHg at 1 year, with mortality similar to the controls (39.2% vs. 40.1%, p = 0.73). Patients with PPMG > 20 mmHg 1 year post-TAVI had higher 4-years mortality than the general population of the registry, unlike patients with MG normalization.

Original languageEnglish
Article number3221
JournalJournal of Clinical Medicine
Volume10
Issue number15
DOIs
StatePublished - 1 Aug 2021
Externally publishedYes

Keywords

  • Mean gradient
  • Post-procedural mean gradient
  • Structural valve degeneration
  • TAVI

ASJC Scopus subject areas

  • Medicine (all)

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