Fluoroscopic assessment of balloon-expandable valve expansion identified patients with marked valve asymmetry at increased risk of late heart failure after TAVR, despite preserved early valve performance.
Of 607 consecutive balloon-expandable valve TAVR patients in a prospective registry, 589 were analyzed, and 17% had heart failure hospitalization within 2 years.
As a continuous variable, the asymmetry index was not independently associated with 2-year HF hospitalization.
An exploratory threshold analysis identified an asymmetry index cutoff of 7.48%, above which 2-year HF hospitalization was more frequent.
The higher HF incidence in patients with greater asymmetry occurred despite comparable rates of impaired valve performance at discharge.
Valve asymmetry >7.48% was independently associated with late HF occurring beyond 30 days after TAVR.
The authors conclude that intraprocedural fluoroscopic valve geometry assessment may help in long-term risk stratification, but needs further investigation.
This study looked at whether the shape of a replacement heart valve, as seen on X-ray imaging during a transcatheter aortic valve replacement (TAVR), relates to later heart failure. In 589 patients who received balloon-expandable valves, researchers measured how uneven the expanded valve looked (the difference between its tallest and shortest sides). About 17% of patients were hospitalized for heart failure within two years. When asymmetry was treated as a smooth scale, it was not clearly linked to heart failure hospitalization. But an exploratory analysis found that patients whose valves were more than about 7.5% asymmetric had more heart failure hospitalizations (23.6% vs 15.8%). This higher risk was seen for heart failure that occurred more than 30 days after the procedure, and it appeared even though standard valve performance checks at discharge looked similar between groups. This research suggests that how evenly a valve expands might carry information about long-term heart failure risk that routine early checks miss. However, the 7.48% cutoff came from an exploratory analysis in a single registry, so the findings need confirmation in further studies before they could be used to guide care.
Kikuchi S, Trimaille A, Carmona A, Granier A, Kibler M, Truong D, et al.. (2026). Impact of Balloon-Expandable Valve Asymmetry on Heart Failure Post Transcatheter Aortic Valve Replacement.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.049304