Evaluation of the Efficacy of Transcatheter Aortic Valve Replacement in Asymptomatic Patients With Severe Aortic Stenosis Using Cardiopulmonary Exercise Testing

BACKGROUND: The management of asymptomatic patients with severe aortic stenosis (AS) remains challenging. While transcatheter aortic valve replacement (TAVR) is established for symptomatic AS, its objective functional benefits in asymptomatic individuals are not well-defined. AIMS: To evaluate the safety and hemodynamic efficacy of TAVR in asymptomatic patients with severe aortic stenosis and to objectively quantify their functional recovery using cardiopulmonary exercise testing (CPET). METHODS: In this single-center retrospective study, 156 asymptomatic patients with severe AS undergoing TAVR with the VitaFlow valve were enrolled. Safety endpoints were adjudicated per Valve Academic Research Consortium (VARC-3) criteria. Efficacy was assessed via serial echocardiography and brain natriuretic peptide (BNP) levels at baseline, 1 day, 7 days, 3 months, and 12 months. Functional capacity was objectively quantified using CPET at baseline, 1 month, and 12 months. RESULTS: Procedural success was 100% with no mortality, stroke, or major complications. Hemodynamics improved immediately (mean gradient: 51.6 ± 11.7 to 13.7 ± 7.2 mmHg, p < 0.001) and remained stable at 12 months. BNP levels decreased significantly from 7 days onward (p < 0.05). CPET revealed substantial improvements in functional capacity: peak oxygen uptake (VO₂) increased from 15.6 ± 3.6 to 19.8 ± 4.0 mL/kg/min (p < 0.001), anaerobic threshold (AT) increased, and ventilatory efficiency (VE/VCO₂ slope) decreased (all p < 0.001). The incidence of exercise-induced adverse events also significantly declined. CONCLUSIONS: TAVR is a safe and highly effective intervention for asymptomatic severe AS, resulting in immediate hemodynamic improvement and sustained, objective enhancement of functional capacity, as rigorously quantified by CPET.