TOPLINE

After transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, a larger left ventricular end‑diastolic diameter and a low baseline transvalvular gradient were associated with incomplete recovery of left ventricular ejection fraction (LVEF); a low baseline gradient was also associated with higher mortality.

METHODOLOGY

• Researchers conducted a retrospective cohort study to assess how mean transvalvular gradient at baseline was associated with LVEF recovery and long-term survival in patients who underwent TAVR.
• The analysis included 257 patients (mean age, 73.4 years; 32% women) with severe aortic stenosis and a reduced LVEF (below 50%) who underwent TAVR at a hospital in China between September 2012 and January 2026.
• Patients underwent echocardiography at baseline, followed by assessments at roughly 1, 3, 6, and 12 months after TAVR, and annually after that; the median follow-up was 37.1 months. All included patients had at least one follow-up echocardiogram.
• Baseline mean transvalvular gradient was assessed in 238 patients: 84 had a low gradient (< 40 mm Hg), and 154 had a high gradient (≥ 40 mm Hg).
• All-cause mortality was the survival outcome.

TAKEAWAY

• Following TAVR, 209 patients (81%) attained a peak LVEF of at least 50%, including 146 who reached 60% or higher. The remaining 48 patients (19%) did not reach 50% and were classified as having incomplete recovery. 
• A larger left ventricular end-diastolic diameter and a lower baseline mean transvalvular gradient were independently linked to incomplete recovery of LVEF (P < .05 for both). The morphology of the bicuspid valve showed no clear association with recovery.
• Estimated survival at 5 years was 66% for those with a low mean transvalvular gradient and 82% for those with a high gradient. A low baseline gradient was associated with a higher rate of mortality (adjusted hazard ratio, 2.44; 95% CI, 1.29-4.65). 
• Neither the trajectory of LVEF recovery nor bicuspid morphology was associated with mortality.

IN PRACTICE

"The gradient is proposed as a prognostic marker, not as a substitute for guideline-based grading of stenosis severity, and whether any change in management according to the baseline gradient improves outcome requires prospective evaluation," the researchers wrote.

SOURCE

The study was led by Fuhai Li of the Affiliated Huizhou Hospital in Huizhou, China. It was published online on October 30 in Heart.

LIMITATIONS

The observational study could not establish cause-and-effect relationships. Researchers defined low-gradient phenotype using mean gradient alone and indexed stroke volume data were unavailable. The study had a long enrollment period during which techniques, devices, and therapies may have changed.

DISCLOSURES

No specific grant funding was declared for this research. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.