{"id":"bb9fb839e3dc","type":"article","url":"https://hartvaat.nl/2026/08/18/echocardiografie-overschatte-drukgradienten-na-tav-in-tav-met-ballon-expandable-/","title":"Echocardiografie overschatte drukgradiënten na TAV-in-TAV met ballon-expandable kleppen","title_en":"Invasive and echocardiographic gradients of self- and balloon-expandable valves in failing aortic bioprostheses.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation","doi":"10.1007/s12471-026-02061-7","source_url":"https://doi.org/10.1007/s12471-026-02061-7","authors":["Sraman Chatterjee","Mark van den Dorpel","Rik Adrichem","Claire Ben Ren","Isabella Kardys","Rutger-Jan Nuis","Joost Daemen","Alexander Hirsch","Marcel L Geleijnse","Nicolas M Van Mieghem"],"significance":5,"published":"2026-08-26","source_date":"2026-08-18","image":"https://hartvaat.nl/global/img/0d47193307ad.webp","kennis":["https://hartvaat.nl/kennis/kleplijden/kleplijden-en-zwangerschap/"],"congress":"","summary_en":"A study of 56 patients undergoing TAV-in-TAV or TAV-in-SAV compared hemodynamics of self-expanding versus balloon-expandable valves. While invasive mean gradients were similar between valve types (6.0 vs 7.0 mmHg), transthoracic echocardiography consistently showed higher gradients for balloon-expandable devices, leading to a significantly larger echo-invasive discrepancy. This highlights the need for cardiologists and imaging specialists to account for valve type when interpreting post-procedural echocardiographic data to avoid misdiagnosing prosthetic dysfunction.","created":"2026-08-19T01:15:23Z","updated":"2026-08-19T01:15:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een studie van 56 patiënten ondergingen cardiologen een TAV-in-TAV of TAV-in-SAV met zelf- of ballon-expandable kleppen. Invasief gemeten gradiënten waren vergelijkbaar (6,0 vs 7,0 mmHg), maar echocardiografische metingen lagen significant hoger bij ballon-expandable kleppen (16,0 vs 10,0 mmHg), wat resulteerde in een grotere discrepantie tussen de meetmethoden. Voor de praktijk betekent dit dat cardiologen en beeldvormers bij follow-up rekening moeten houden met het kleptype om foutieve interpretaties van obstructie te voorkomen.","abstract_original":"BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an established treatment for a failing aortic bioprosthesis. The hemodynamics of TAVI in degenerated transcatheter or surgical aortic valves (TAV-in-TAV or TAV-in-SAV) are unknown. We aimed to investigate hemodynamic differences between self- and balloon-expandable TAV-in-TAV and TAV-in-SAV groups, and transthoracic echocardiography-derived (TTE) versus invasive transaortic pressure gradients. METHODS: Patients ≥ 18 years with a self-expanding EVOLUT (SEV) or balloon-expandable SAPIEN3 (BEV) valve for TAV-in-TAV or TAV-in-SAV were included. Transaortic gradients were determined invasively and by TTE within 48 h post-intervention. RESULTS: We identified 56 patients with SEV (n = 36) or BEV (n = 20) TAV in a failing aortic bioprosthesis. Fourteen cases involved failing transcatheter valves and 42 surgical bioprostheses. Invasive mean gradients were similar after BEV and SEV (median (25th-75th percentile): 6.0 (1.5-6.5) vs 7.0 (2.0-10.0) mm Hg, p = 0.109). Mean gradients by TTE were higher for BEV than SEV at discharge (16.0 (10.8-19.8) versus 10.0 (7.0-12.0) mm Hg, p = 0.003) and 12-month follow-up (13.0 (11.0-15.5) versus 9.0 (7.0-12.3) mm Hg, p = 0.025). The discrepancy between TTE and invasive mean gradients was significantly larger for BEV than SEV (13.0 (6.3-14.0) vs 3.0 (1.5-8.3) mm Hg, p = 0.001) and most pronounced in TAV-in-SAV (BEV 13.0 (6.3-17.0) vs SEV 3.0 (1.0-8.5) mm Hg, p = 0.004). CONCLUSION: Mean gradient after TAV in a failing bioprosthesis is similar for BEV and SEV, when measured invasively, but higher with BEV than SEV by TTE. The discordance between invasive and TTE-derived mean gradients is the largest in BEV."}