Prognostic value of algorithm-based invasive hemodynamic assessment of paravalvular regurgitation after Transcatheter Aortic Valve Replacement with Self-Expanding Devices – the APPOSE registry

Structured Abstract Background Detecting and grading of paravalvular regurgitation (PVR) following Transcatheter Aortic Valve Replacement (TAVR) remains challenging. Aims We evaluated the prognostic value of algorithm-based invasively-measured hemodynamic indices of PVR for all-cause mortality and heart failure (HF) rehospitalisations. Methods and Results We included 727 patients who underwent TAVR with a self-expanding valve for severe native aortic stenosis between 2015 and 2021 in the Radboudumc. Invasive left ventricular and aortic pressures were continuously measured, and were analysed offline using a validated algorithm for standardized computation of hemodynamic indices of PVR. The primary endpoint was an event-adjudicated composite of all-cause mortality and HF rehospitalisation across three-year follow-up. Algorithm-derived diastolic pressure-time index (DPTI)≤58 and diastolic delta (DD)≤32mmHg 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≤58mmHg: 2.94, 95%CI: 1.68, 5.15) but not none/trace PVR (HR DPTI≤58mmHg: 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). Conclusion Algorithm-based invasive assessment of PVR showed independent prognostic value for the risk of all-cause mortality and HF rehospitalisation across three-year follow-up. Additionally, following stratification for angiography-graded PVR, hemodynamic 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 hemodynamics for risk stratification of patients undergoing TAVR.