High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry

Francesco Tartaglia; Mauro Gitto; Won-Keun Kim; Pier Pasquale Leone; Tommaso Fabris; Chiara De Biase; Giuliano Costa; Nicholas Montarello; Andrea Scotti; Michele Bellamoli; Mesfer Alfadhel; Ofir Koren; Simone Fezzi; Barbara Bellini; Mauro Massussi; Giulia Costa; Chiara Fraccaro; Alessandro Mazzapicchi; Enrico Giacomin; Francesco Burzotta; Andrea Zito; Riccardo Gorla; Marco Angelillis; Karsten Hug; Carlo Briguori; Luca Bettari; Antonio Messina; Michele Galasso; Damiano Regazzoli; Greta Cattaneo; Mauro Boiago; Gianmaria Calamita; Giulia Laterra; Matthias Renker; Mario Garcia Gomez; Alfonso Ielasi; Uri Landes; Tobias Rheude; Francesco Bedogni; Ignacio Amat Santos; Francesco Saia; Lin Bai; Mao Chen; Marianna Adamo; Marco De Carlo; Matteo Montorfano; Raj R Makkar; Darren Mylotte; Daniel J Blackman; Marco Barbanti; Didier Tchetche; Giuseppe Tarantini; Azeem Latib; Diego Maffeo; Ole De Backer; Andrea Buono; Antonio Mangieri

doi:10.1007/s00392-025-02726-0

High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry

Francesco Tartaglia, Mauro Gitto, Won-Keun Kim, Pier Pasquale Leone, Tommaso Fabris, Chiara De Biase, Giuliano Costa, Nicholas Montarello, Andrea Scotti, Michele Bellamoli, Mesfer Alfadhel, Ofir Koren, Simone Fezzi, Barbara Bellini, Mauro Massussi, Giulia Costa, Chiara Fraccaro, Alessandro Mazzapicchi, Enrico Giacomin, Francesco BurzottaAndrea Zito, Riccardo Gorla, Marco Angelillis, Karsten Hug, Carlo Briguori, Luca Bettari, Antonio Messina, Michele Galasso, Damiano Regazzoli, Greta Cattaneo, Mauro Boiago, Gianmaria Calamita, Giulia Laterra, Matthias Renker, Mario Garcia Gomez, Alfonso Ielasi, Uri Landes, Tobias Rheude, Francesco Bedogni, Ignacio Amat Santos, Francesco Saia, Lin Bai, Mao Chen, Marianna Adamo, Marco De Carlo, Matteo Montorfano, Raj R Makkar, Darren Mylotte, Daniel J Blackman, Marco Barbanti, Didier Tchetche, Giuseppe Tarantini, Azeem Latib, Diego Maffeo, Ole De Backer, Andrea Buono, Antonio Mangieri^*

^*Corresponding author for this work

Department of Cardiology

2 Citations (Scopus)

Abstract

BACKGROUND: Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).

OBJECTIVE: To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.

METHODS: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled. HRG were defined as a mean transvalvular gradient ≥ 20 mmHg at 30 days, according to Valve Academic Research Consortium-3 (VARC-3) criteria. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, neurologic events or hospitalization for heart failure, assessed at 3 years after TAVI. Secondary endpoints included the single components of the primary outcome. Endpoints were assessed according to the presence of HRG, before and after covariate adjustment for clinically relevant confounders.

RESULTS: A total of 972 patients were enrolled. HRG post-TAVI were found in 35 patients (3.6%). Patients with HRG had a higher preprocedural aortic valve gradient (57.0 [interquartile range: 49.0-69.0] mmHg vs 48.0 [40.0-58.0] mmHg, p < 0.001) and received smaller transcatheter heart valve (THV) (26.0 [23.0-29.0] mm vs 29.0 [26.0-29.0] mm, p < 0.001) when compared to patients with normal residual gradients (NRG). The only independent predictor of HRG was a bioprosthesis size ≤ 23 mm. At 3 years, MACE occurred in 35.0% of HRG patients and 22.3% of NRG patients (adjusted hazard ratio [HR]: 2.41, 95% confidence interval [CI]: 1.15-5.04; p = 0.019). HRG patients had a higher risk of neurologic events as compared to NRG patients (13.3% versus 4.5%, adjusted HR: 4.50, 95% CI: 1.52-13.30, p = 0.007).

CONCLUSIONS: After TAVI in Sievers type 1 BAV stenosis, HRG occurred in around 4% of cases and were associated with an increased risk of MACE and neurologic events.

Original language	English
Journal	Clinical research in cardiology : official journal of the German Cardiac Society
Volume	114
Issue number	11
Pages (from-to)	1595-1605
Number of pages	11
ISSN	1861-0684
DOIs	https://doi.org/10.1007/s00392-025-02726-0
Publication status	Published - Nov 2025

Keywords

Aged
Aged, 80 and over
Aortic Valve Stenosis/surgery
Aortic Valve/surgery
Bicuspid Aortic Valve Disease/surgery
Female
Follow-Up Studies
Humans
Incidence
Male
Postoperative Complications/epidemiology
Registries
Risk Factors
Transcatheter Aortic Valve Replacement/adverse effects
Treatment Outcome
Bicuspid
Transcatheter aortic valve intervention
Gradients

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10.1007/s00392-025-02726-0

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Tartaglia, F., Gitto, M., Kim, W.-K., Leone, P. P., Fabris, T., De Biase, C., Costa, G., Montarello, N., Scotti, A., Bellamoli, M., Alfadhel, M., Koren, O., Fezzi, S., Bellini, B., Massussi, M., Costa, G., Fraccaro, C., Mazzapicchi, A., Giacomin, E., ... Mangieri, A. (2025). High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry. Clinical research in cardiology : official journal of the German Cardiac Society, 114(11), 1595-1605. https://doi.org/10.1007/s00392-025-02726-0

High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry. / Tartaglia, Francesco; Gitto, Mauro; Kim, Won-Keun et al.
In: Clinical research in cardiology : official journal of the German Cardiac Society, Vol. 114, No. 11, 11.2025, p. 1595-1605.

Research output: Contribution to journal › Journal article › Research › peer-review

Tartaglia, F, Gitto, M, Kim, W-K, Leone, PP, Fabris, T, De Biase, C, Costa, G, Montarello, N, Scotti, A, Bellamoli, M, Alfadhel, M, Koren, O, Fezzi, S, Bellini, B, Massussi, M, Costa, G, Fraccaro, C, Mazzapicchi, A, Giacomin, E, Burzotta, F, Zito, A, Gorla, R, Angelillis, M, Hug, K, Briguori, C, Bettari, L, Messina, A, Galasso, M, Regazzoli, D, Cattaneo, G, Boiago, M, Calamita, G, Laterra, G, Renker, M, Garcia Gomez, M, Ielasi, A, Landes, U, Rheude, T, Bedogni, F, Amat Santos, I, Saia, F, Bai, L, Chen, M, Adamo, M, De Carlo, M, Montorfano, M, Makkar, RR, Mylotte, D, Blackman, DJ, Barbanti, M, Tchetche, D, Tarantini, G, Latib, A, Maffeo, D, De Backer, O, Buono, A & Mangieri, A 2025, 'High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry', Clinical research in cardiology : official journal of the German Cardiac Society, vol. 114, no. 11, pp. 1595-1605. https://doi.org/10.1007/s00392-025-02726-0

@article{c2587278f0a0436b922717305236565b,

title = "High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry",

abstract = "BACKGROUND: Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).OBJECTIVE: To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.METHODS: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled. HRG were defined as a mean transvalvular gradient ≥ 20 mmHg at 30 days, according to Valve Academic Research Consortium-3 (VARC-3) criteria. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, neurologic events or hospitalization for heart failure, assessed at 3 years after TAVI. Secondary endpoints included the single components of the primary outcome. Endpoints were assessed according to the presence of HRG, before and after covariate adjustment for clinically relevant confounders.RESULTS: A total of 972 patients were enrolled. HRG post-TAVI were found in 35 patients (3.6\%). Patients with HRG had a higher preprocedural aortic valve gradient (57.0 [interquartile range: 49.0-69.0] mmHg vs 48.0 [40.0-58.0] mmHg, p < 0.001) and received smaller transcatheter heart valve (THV) (26.0 [23.0-29.0] mm vs 29.0 [26.0-29.0] mm, p < 0.001) when compared to patients with normal residual gradients (NRG). The only independent predictor of HRG was a bioprosthesis size ≤ 23 mm. At 3 years, MACE occurred in 35.0\% of HRG patients and 22.3\% of NRG patients (adjusted hazard ratio [HR]: 2.41, 95\% confidence interval [CI]: 1.15-5.04; p = 0.019). HRG patients had a higher risk of neurologic events as compared to NRG patients (13.3\% versus 4.5\%, adjusted HR: 4.50, 95\% CI: 1.52-13.30, p = 0.007).CONCLUSIONS: After TAVI in Sievers type 1 BAV stenosis, HRG occurred in around 4\% of cases and were associated with an increased risk of MACE and neurologic events.",

keywords = "Aged, Aged, 80 and over, Aortic Valve Stenosis/surgery, Aortic Valve/surgery, Bicuspid Aortic Valve Disease/surgery, Female, Follow-Up Studies, Humans, Incidence, Male, Postoperative Complications/epidemiology, Registries, Risk Factors, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, Bicuspid, Transcatheter aortic valve intervention, Gradients",

author = "Francesco Tartaglia and Mauro Gitto and Won-Keun Kim and Leone, \{Pier Pasquale\} and Tommaso Fabris and \{De Biase\}, Chiara and Giuliano Costa and Nicholas Montarello and Andrea Scotti and Michele Bellamoli and Mesfer Alfadhel and Ofir Koren and Simone Fezzi and Barbara Bellini and Mauro Massussi and Giulia Costa and Chiara Fraccaro and Alessandro Mazzapicchi and Enrico Giacomin and Francesco Burzotta and Andrea Zito and Riccardo Gorla and Marco Angelillis and Karsten Hug and Carlo Briguori and Luca Bettari and Antonio Messina and Michele Galasso and Damiano Regazzoli and Greta Cattaneo and Mauro Boiago and Gianmaria Calamita and Giulia Laterra and Matthias Renker and \{Garcia Gomez\}, Mario and Alfonso Ielasi and Uri Landes and Tobias Rheude and Francesco Bedogni and \{Amat Santos\}, Ignacio and Francesco Saia and Lin Bai and Mao Chen and Marianna Adamo and \{De Carlo\}, Marco and Matteo Montorfano and Makkar, \{Raj R\} and Darren Mylotte and Blackman, \{Daniel J\} and Marco Barbanti and Didier Tchetche and Giuseppe Tarantini and Azeem Latib and Diego Maffeo and \{De Backer\}, Ole and Andrea Buono and Antonio Mangieri",

note = "{\textcopyright} 2025. Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2025",

month = nov,

doi = "10.1007/s00392-025-02726-0",

language = "English",

volume = "114",

pages = "1595--1605",

journal = "Clinical research in cardiology : official journal of the German Cardiac Society",

issn = "1861-0684",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "11",

}

TY - JOUR

T1 - High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis

T2 - insights from the AD-HOC registry

AU - Tartaglia, Francesco

AU - Gitto, Mauro

AU - Kim, Won-Keun

AU - Leone, Pier Pasquale

AU - Fabris, Tommaso

AU - De Biase, Chiara

AU - Costa, Giuliano

AU - Montarello, Nicholas

AU - Scotti, Andrea

AU - Bellamoli, Michele

AU - Alfadhel, Mesfer

AU - Koren, Ofir

AU - Fezzi, Simone

AU - Bellini, Barbara

AU - Massussi, Mauro

AU - Costa, Giulia

AU - Fraccaro, Chiara

AU - Mazzapicchi, Alessandro

AU - Giacomin, Enrico

AU - Burzotta, Francesco

AU - Zito, Andrea

AU - Gorla, Riccardo

AU - Angelillis, Marco

AU - Hug, Karsten

AU - Briguori, Carlo

AU - Bettari, Luca

AU - Messina, Antonio

AU - Galasso, Michele

AU - Regazzoli, Damiano

AU - Cattaneo, Greta

AU - Boiago, Mauro

AU - Calamita, Gianmaria

AU - Laterra, Giulia

AU - Renker, Matthias

AU - Garcia Gomez, Mario

AU - Ielasi, Alfonso

AU - Landes, Uri

AU - Rheude, Tobias

AU - Bedogni, Francesco

AU - Amat Santos, Ignacio

AU - Saia, Francesco

AU - Bai, Lin

AU - Chen, Mao

AU - Adamo, Marianna

AU - De Carlo, Marco

AU - Montorfano, Matteo

AU - Makkar, Raj R

AU - Mylotte, Darren

AU - Blackman, Daniel J

AU - Barbanti, Marco

AU - Tchetche, Didier

AU - Tarantini, Giuseppe

AU - Latib, Azeem

AU - Maffeo, Diego

AU - De Backer, Ole

AU - Buono, Andrea

AU - Mangieri, Antonio

PY - 2025/11

Y1 - 2025/11

N2 - BACKGROUND: Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).OBJECTIVE: To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.METHODS: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled. HRG were defined as a mean transvalvular gradient ≥ 20 mmHg at 30 days, according to Valve Academic Research Consortium-3 (VARC-3) criteria. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, neurologic events or hospitalization for heart failure, assessed at 3 years after TAVI. Secondary endpoints included the single components of the primary outcome. Endpoints were assessed according to the presence of HRG, before and after covariate adjustment for clinically relevant confounders.RESULTS: A total of 972 patients were enrolled. HRG post-TAVI were found in 35 patients (3.6%). Patients with HRG had a higher preprocedural aortic valve gradient (57.0 [interquartile range: 49.0-69.0] mmHg vs 48.0 [40.0-58.0] mmHg, p < 0.001) and received smaller transcatheter heart valve (THV) (26.0 [23.0-29.0] mm vs 29.0 [26.0-29.0] mm, p < 0.001) when compared to patients with normal residual gradients (NRG). The only independent predictor of HRG was a bioprosthesis size ≤ 23 mm. At 3 years, MACE occurred in 35.0% of HRG patients and 22.3% of NRG patients (adjusted hazard ratio [HR]: 2.41, 95% confidence interval [CI]: 1.15-5.04; p = 0.019). HRG patients had a higher risk of neurologic events as compared to NRG patients (13.3% versus 4.5%, adjusted HR: 4.50, 95% CI: 1.52-13.30, p = 0.007).CONCLUSIONS: After TAVI in Sievers type 1 BAV stenosis, HRG occurred in around 4% of cases and were associated with an increased risk of MACE and neurologic events.

AB - BACKGROUND: Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).OBJECTIVE: To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.METHODS: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled. HRG were defined as a mean transvalvular gradient ≥ 20 mmHg at 30 days, according to Valve Academic Research Consortium-3 (VARC-3) criteria. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, neurologic events or hospitalization for heart failure, assessed at 3 years after TAVI. Secondary endpoints included the single components of the primary outcome. Endpoints were assessed according to the presence of HRG, before and after covariate adjustment for clinically relevant confounders.RESULTS: A total of 972 patients were enrolled. HRG post-TAVI were found in 35 patients (3.6%). Patients with HRG had a higher preprocedural aortic valve gradient (57.0 [interquartile range: 49.0-69.0] mmHg vs 48.0 [40.0-58.0] mmHg, p < 0.001) and received smaller transcatheter heart valve (THV) (26.0 [23.0-29.0] mm vs 29.0 [26.0-29.0] mm, p < 0.001) when compared to patients with normal residual gradients (NRG). The only independent predictor of HRG was a bioprosthesis size ≤ 23 mm. At 3 years, MACE occurred in 35.0% of HRG patients and 22.3% of NRG patients (adjusted hazard ratio [HR]: 2.41, 95% confidence interval [CI]: 1.15-5.04; p = 0.019). HRG patients had a higher risk of neurologic events as compared to NRG patients (13.3% versus 4.5%, adjusted HR: 4.50, 95% CI: 1.52-13.30, p = 0.007).CONCLUSIONS: After TAVI in Sievers type 1 BAV stenosis, HRG occurred in around 4% of cases and were associated with an increased risk of MACE and neurologic events.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Valve Stenosis/surgery

KW - Aortic Valve/surgery

KW - Bicuspid Aortic Valve Disease/surgery

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Incidence

KW - Male

KW - Postoperative Complications/epidemiology

KW - Registries

KW - Risk Factors

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

KW - Bicuspid

KW - Transcatheter aortic valve intervention

KW - Gradients

UR - https://www.scopus.com/pages/publications/105012843826

U2 - 10.1007/s00392-025-02726-0

DO - 10.1007/s00392-025-02726-0

M3 - Journal article

C2 - 40767990

SN - 1861-0684

VL - 114

SP - 1595

EP - 1605

JO - Clinical research in cardiology : official journal of the German Cardiac Society

JF - Clinical research in cardiology : official journal of the German Cardiac Society

IS - 11

ER -

High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry

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