Invasive Hemodynamic Assessment Is Mandatory to Confirm Bioprosthetic Valve Dysfunction and Failure Following TAVR

Echocardiography is commonly used for clinical evaluation of bioprosthetic valves. However, the clinical significance of an isolated high gradient detected by echocardiography is unclear. This uncertainty arises from discrepancies between echocardiographic and invasive gradient measurements in normally functioning prosthetic valves, that is attributed to limitations of the Bernoulli principle among other factors. Furthermore, the relationship between echocardiographic gradient and clinical outcomes is complex and nonlinear. To avoid unnecessary interventions, it is crucial to confirm an unfavorable gradient detected by echocardiography through invasive measurements, particularly when valve thrombosis is absent.