Impact of Anticoagulation on Valve Hemodynamics Following Transcatheter Valve-In-Valve Implantation

Background: Transcatheter aortic valve implantation (TAVI) for prosthetic valve dysfunction is frequently associated with suboptimal echocardiographic outcomes.The effect of anticoagulation on preserving valve function is not well understood. Methods:Patients who underwent the valve-in-valve TAVI for failed prosthetic aortic valves between 2015 and 2023 at a large academic medical center were retrospectively included.Data on anticoagulation use, along with clinical and echocardiographic outcomes, were collected.The end point of the study was the effect of anticoagulation use on the changes in mean gradient, peak velocity (V max ), and dimensionless index over time.Results: One hundred thirteen patients (43 women) with a mean Society of Thoracic Surgeons score of 5.8 ± 5.5 were included in the study.Of these, 42% underwent valve fracture, and anticoagulation was used in 69.3% patients at discharge and 53.3% at 1-year follow-up.The mean gradient (β = 4.46, P < .001)and V max (β = 0.292, P < .001)increased, whereas dimensionless index decreased over time in the overall cohort (β = -0.06,P = .001).However, there was a significant effect of anticoagulation use on changes in mean gradient (β = -4.36,P = .003)and V max (β = -0.30,P = .003)but not on DI (β = 0.40, P = .104)at 1-year post-TAVI.Conclusions: Anticoagulation postvalve-in-valve TAVI may lead to lower mean gradients and peak velocities at 1-year follow-up.More data are needed to understand its impact on nonflow-dependent indices and clinical outcomes.