title: Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement: Multicenter Registry.
abstract: BACKGROUND
  Scarce data exist on the incidence of and factors associated with valve hemodynamic deterioration (VHD) after transcatheter aortic valve replacement (TAVR).
  
  
  OBJECTIVE
  This study sought to determine the incidence, timing, and predictors of VHD in a large cohort of patients undergoing TAVR.
  
  
  METHODS
  This multicenter registry included 1,521 patients (48% male; 80 ± 7 years of age) who underwent TAVR. Mean echocardiographic follow-up was 20 ± 13 months (minimum: 6 months). Echocardiographic examinations were performed at discharge, at 6 to 12 months, and yearly thereafter. Annualized changes in mean gradient (mm Hg/year) were calculated by dividing the difference between the mean gradient at last follow-up and the gradient at discharge by the time between examinations. VHD was defined as a ≥10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessment.
  
  
  RESULTS
  The overall mean annualized rate of transprosthetic gradient progression during follow-up was 0.30 ± 4.99 mm Hg/year. A total of 68 patients met criteria of VHD (incidence: 4.5% during follow-up). The absence of anticoagulation therapy at hospital discharge (p = 0.002), a valve-in-valve (TAVR in a surgical valve) procedure (p = 0.032), the use of a 23-mm valve (p = 0.016), and a greater body mass index (p = 0.001) were independent predictors of VHD.
  
  
  CONCLUSIONS
  There was a mild but significant increase in transvalvular gradients over time after TAVR. The lack of anticoagulation therapy, a valve-in-valve procedure, a greater body mass index, and the use of a 23-mm transcatheter valve were associated with higher rates of VHD post-TAVR. Further prospective studies are required to determine whether a specific antithrombotic therapy post-TAVR may reduce the risk of VHD.
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Maria
authors: M
authors: Del Trigo
authors: Hospital Universitario Virgen de la Victoria, Malaga, Spain.
authors: Antonio J
authors: AJ
authors: Muñoz-Garcia
authors: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Harindra C
authors: HC
authors: Wijeysundera
authors: Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors: Luis
authors: L
authors: Nombela-Franco
authors: St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors: Asim N
authors: AN
authors: Cheema
authors: Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors: Enrique
authors: E
authors: Gutierrez
authors: Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Vicenç
authors: V
authors: Serra
authors: Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors: Joelle
authors: J
authors: Kefer
authors: Hospital Clinico Univeritario de Valladolid, Valladolid, Spain.
authors: Ignacio J
authors: IJ
authors: Amat-Santos
authors: Clinica de Occidente de Cali, Valle del Cauca, Colombia.
authors: Luis M
authors: LM
authors: Benitez
authors: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Jumana
authors: J
authors: Mewa
authors: Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors: Pilar
authors: P
authors: Jiménez-Quevedo
authors: St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors: Sami
authors: S
authors: Alnasser
authors: Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Bruno
authors: B
authors: Garcia Del Blanco
authors: Clinica de Occidente de Cali, Valle del Cauca, Colombia.
authors: Antonio
authors: A
authors: Dager
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Omar
authors: O
authors: Abdul-Jawad Altisent
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Rishi
authors: R
authors: Puri
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Francisco
authors: F
authors: Campelo-Parada
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Abdellaziz
authors: A
authors: Dahou
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Jean-Michel
authors: JM
authors: Paradis
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Eric
authors: E
authors: Dumont
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Philippe
authors: P
authors: Pibarot
authors: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011379:Prognosis; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: anticoagulation therapy; transcatheter aortic valve replacement; valve degeneration; valve-in-valve