Prognostic value of algorithm-based invasive haemodynamic assessment of paravalvular regurgitation after transcatheter aortic valve replacement with self-expanding devices—the APPOSE registry

Detecting and grading paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) remains challenging.

We evaluated the prognostic value of algorithm-based invasively measured haemodynamic indices of PVR for all-cause mortality and heart failure (HF) rehospitalizations.

We included 727 patients who underwent TAVR with a self-expanding valve for severe native aortic stenosis between 2015 and 2021 at Radboudumc. Invasive left ventricular and aortic pressures were continuously measured and analysed offline using a validated algorithm for standardized computation of haemodynamic indices of PVR. The primary endpoint was an event-adjudicated composite of all-cause mortality and HF rehospitalization across 3-year follow-up. Algorithm-derived diastolic pressure–time index (DPTI) ≤58 and diastolic delta (DD) ≤32 mmHg were independently associated with the composite outcome (hazard ratio [HR] 1.64 [95% confidence interval (CI): 1.14, 2.37], HR 1.80 [95% CI: 1.21, 2.68], respectively). Following stratification for angiography-graded PVR, algorithm-derived invasive indices remained independently associated with the composite outcome in those with angiographic mild-moderate (HR DPTI ≤58 mmHg: 2.94, 95% CI: 1.68, 5.15) but not none/trace PVR (HR DPTI ≤58 mmHg: 0.91, 95% CI: 0.49, 1.69). Inferences remained consistent when considering only those with angiographic mild PVR (HR DPTI ≤58: 3.19, 95% CI: 1.62, 6.26).

Algorithm-based invasive assessment of PVR showed independent prognostic value for the risk of all-cause mortality and HF rehospitalization across 3-year follow-up. Additionally, following stratification for angiography-graded PVR, haemodynamic indices remained independently associated with the composite outcome in those with angiographic mild PVR. Together, this highlights the potential of real-time automated assessment of invasive haemodynamics for risk stratification of patients undergoing TAVR.