TY - JOUR
T1 - Different Types of Aortic Valve Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement
AU - Hemelrijk, Kimberley I.
AU - Aarts, Hugo M.
AU - Broeze, Gijs M.
AU - Menchero, Antonio Gomez
AU - Tchétché, Didier
AU - de Brito, Fabio S.
AU - Barbanti, Marco
AU - Kornowski, Ran
AU - Latib, Azeem
AU - D’Onofrio, Augusto
AU - Ribichini, Flavio
AU - Urdaci, Miguel Artaiz
AU - Dumonteil, Nicolas
AU - Abizaid, Alexandre
AU - Sartori, Samantha
AU - Rosato, Stefano
AU - Tarantini, Giuseppe
AU - Pesarini, Gabriele
AU - Orvin, Katia
AU - Pagnesi, Matteo
AU - Vaquerizo, Beatriz
AU - Dangas, George
AU - Mehran, Roxana
AU - van Nieuwkerk, Astrid C.
AU - Delewi, Ronak
N1 - Publisher Copyright:
© 2026 The Author(s).
PY - 2026/5
Y1 - 2026/5
N2 - Background Transcatheter aortic valve replacement (TAVR) is an effective treatment in patients with “classical” concordant high-gradient aortic stenosis (AS). However, data on outcomes in patients with discordant AS are scarce. Our study aims to investigate the clinical outcomes of patients undergoing TAVR with different types of AS. Methods The Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation 2 (CENTER2) study is a patient-level database including 25,771 patients who underwent TAVR, of whom 15,233 were included in this analysis. Four AS subgroups were identified, and patients were classified as discordant AS (low-gradient AS with preserved or impaired left ventricular ejection fraction [LVEF] or discordant high-gradient AS) or concordant high-gradient AS. Results A total of 15,233 patients underwent TAVR. The mean age was 81.5 ± 6.8 years, 56% were women, and Society of Thoracic Surgeons Predicted Risk of Mortality was 4.8% (interquartile range [IQR] 3.0-8.0%). Of these, 2731 (17.9%) patients had low-gradient AS with preserved or impaired LVEF, 138 (0.9%) discordant high-gradient AS, and 12,364 (81.2%) concordant high-gradient AS. There was no difference in 1-year mortality between discordant AS and concordant high-gradient AS (13.1 vs. 11.9%, adjusted hazard ratio 1.19, p = 0.08). One-year mortality rates was higher in low-gradient AS with impaired LVEF compared to concordant high-gradient AS (15.9 vs. 11.9%, adjusted hazard ratio 1.43, p = 0.01). Patients with concordant high-gradient AS had higher major bleeding rates (6.7%) compared to both low-gradient AS with impaired LVEF (4.0%) and preserved LVEF (5.4%) ( p < 0.001 and p = 0.04). Conclusions Nearly 20% of patients undergoing TAVR had discordant AS. One-year mortality was higher in low-gradient AS with impaired LVEF, whereas outcomes were similar among low-gradient with preserved LVEF, discordant high-gradient, and concordant high-gradient AS.
AB - Background Transcatheter aortic valve replacement (TAVR) is an effective treatment in patients with “classical” concordant high-gradient aortic stenosis (AS). However, data on outcomes in patients with discordant AS are scarce. Our study aims to investigate the clinical outcomes of patients undergoing TAVR with different types of AS. Methods The Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation 2 (CENTER2) study is a patient-level database including 25,771 patients who underwent TAVR, of whom 15,233 were included in this analysis. Four AS subgroups were identified, and patients were classified as discordant AS (low-gradient AS with preserved or impaired left ventricular ejection fraction [LVEF] or discordant high-gradient AS) or concordant high-gradient AS. Results A total of 15,233 patients underwent TAVR. The mean age was 81.5 ± 6.8 years, 56% were women, and Society of Thoracic Surgeons Predicted Risk of Mortality was 4.8% (interquartile range [IQR] 3.0-8.0%). Of these, 2731 (17.9%) patients had low-gradient AS with preserved or impaired LVEF, 138 (0.9%) discordant high-gradient AS, and 12,364 (81.2%) concordant high-gradient AS. There was no difference in 1-year mortality between discordant AS and concordant high-gradient AS (13.1 vs. 11.9%, adjusted hazard ratio 1.19, p = 0.08). One-year mortality rates was higher in low-gradient AS with impaired LVEF compared to concordant high-gradient AS (15.9 vs. 11.9%, adjusted hazard ratio 1.43, p = 0.01). Patients with concordant high-gradient AS had higher major bleeding rates (6.7%) compared to both low-gradient AS with impaired LVEF (4.0%) and preserved LVEF (5.4%) ( p < 0.001 and p = 0.04). Conclusions Nearly 20% of patients undergoing TAVR had discordant AS. One-year mortality was higher in low-gradient AS with impaired LVEF, whereas outcomes were similar among low-gradient with preserved LVEF, discordant high-gradient, and concordant high-gradient AS.
KW - Aortic stenosis
KW - Low gradient
KW - TAVR
UR - https://www.scopus.com/pages/publications/105032493917
U2 - 10.1016/j.shj.2026.100817
DO - 10.1016/j.shj.2026.100817
M3 - Article
AN - SCOPUS:105032493917
SN - 2474-8706
VL - 10
JO - Structural Heart
JF - Structural Heart
IS - 5
M1 - 100817
ER -