Early hemodynamic impact of hypoattenuated leaflet thickening in new-generation transcatheter heart valves
K Hattori, K Matsushita, K Terasaka, T Yoshii, S Kikuchi, K Tsutsumi, H Kirigaya, H Nakahashi, T Cho, K Okada, T Ebina, M Kosuge, N Iwahashi, K Uchida, K HibiAbstract
Background/Introduction
The incidence and hemodynamic impact of hypoattenuated leaflet thickening (HALT) in new-generation transcatheter heart valves (THVs) have not been fully elucidated.
Purposes
The purpose of this study is to investigate the hemodynamic impact of HALT.
Methods
We enrolled 306 cases of transcatheter aortic valve implantation (TAVI) performed between July 2023 and October 2025. Balloon-expandable valves (BEVs) included Sapien3 Ultra RESILIA, while self-expanding valves (SEVs) included Evolut FX, Evolut FX+, and Navitor. A total of 212 patients with both one-month follow-up computed tomography and echocardiography were analyzed.
Results
BEV and SEV were implanted in 106 patients each. The incidence of HALT was significantly lower in the BEV group compared with the SEV group (21% vs. 36%, p=0.01). In the SEV group, the presence of HALT did not significantly affect the mean transprosthetic pressure gradient (PG) (8.5 mmHg vs. 8.8 mmHg, p=0.65). In contrast, HALT was associated with a significantly higher mean PG in the BEV group (12.5 mmHg vs. 9.8 mmHg, p=0.02). Notably, this effect was evident only in patients receiving 20mm (25.7 mmHg vs. 14.8 mmHg, p=0.053) and 23mm BEVs (11.9 mmHg vs. 9.8mmHg, p=0.044).
Conclusion
Among new-generation THVs, HALT was less frequent in BEVs compared with SEVs. However, HALT at one month after TAVI was associated with an increased mean PG in BEVs, particularly in smaller THVs.