{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:39:54Z","timestamp":1784709594403,"version":"3.55.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Lower (&lt;10 mm\u2009Hg) discharge echocardiographic mean gradients (MGs) following transcatheter aortic valve replacement with balloon-expandable valves are associated with lower ejection fraction and higher 5-year mortality compared with higher gradients. Using the Society of Thoracic Surgeons\/American College of Cardiology Transcatheter Valve Therapy Registry, we studied the relationship between echocardiographic MG and patient prosthesis mismatch (PPM) following transcatheter aortic valve-in-valve replacement and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Patients who underwent aortic valve-in-valve replacement with a balloon-expandable valve from July 2015 to December 2023 in the Society of Thoracic Surgeons\/American College of Cardiology Transcatheter Valve Therapy Registry were included. Adjusted Cox models with regression splines explored the relationship between MG and 5-year mortality. Kaplan-Meier estimates and adjusted hazard ratios compared the occurrence of 5-year mortality between gradient cutoffs and PPM presence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 13\u2009054 patients were included; spline curves demonstrated a nonlinear relationship between discharge MG and 5-year mortality. Kaplan-Meier curves suggested higher 5-year mortality with MG &lt;10 mm\u2009Hg compared with MG \u226510 mm\u2009Hg (hazard ratio, 1.15 [95% CI, 1.02\u20131.29];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.024). MG &lt;10 mm\u2009Hg was associated with lower ejection fraction compared with higher MG (50.4\u00b113.9 versus 53.2\u00b112.8;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001). Severe PPM and MG \u226520 mm\u2009Hg were not associated with worse 5-year outcomes compared with none\/moderate PPM or MG \u226420 mm\u2009Hg, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Discharge MG &lt;10 mm\u2009Hg is associated with lower ejection fraction and increased 5-year mortality following aortic valve-in-valve replacement compared with higher MG in a nonlinear fashion. Severe PPM and MG &gt; 20 mm\u2009Hg were not associated with worse 5-year clinical outcomes. Incorporating data on ejection fraction with PPM and MG is important before determining the need for valve optimization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.125.015945","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T10:00:14Z","timestamp":1770631214000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Hemodynamics and Mid-Term Clinical Outcomes Following Valve-in-Valve TAVR With Balloon-Expandable Valves"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7316-4247","authenticated-orcid":true,"given":"Amr E.","family":"Abbas","sequence":"first","affiliation":[{"name":"Corewell Health East, William Beaumont University Hospital, Royal Oak, MI (A.E.A., T.A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6500-7471","authenticated-orcid":true,"given":"Tsuyoshi","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Washington University in St. Louis, MO (T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houman","family":"Khalili","sequence":"additional","affiliation":[{"name":"Memorial Healthcare System, Hollywood, FL (H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-3391","authenticated-orcid":true,"given":"Samir R.","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (S.R.K., G.W.R., A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9438-0846","authenticated-orcid":true,"given":"Vasilis C.","family":"Babaliaros","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (V.C.B., A.B.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7496-5954","authenticated-orcid":true,"given":"Adam B.","family":"Greenbaum","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (V.C.B., A.B.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4272-1140","authenticated-orcid":true,"given":"Thomas A.","family":"Schwann","sequence":"additional","affiliation":[{"name":"Corewell Health East, William Beaumont University Hospital, Royal Oak, MI (A.E.A., T.A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep","family":"Yadav","sequence":"additional","affiliation":[{"name":"Piedmont Heart Institute, Atlanta, GA (P.Y., V.H.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5091-624X","authenticated-orcid":true,"given":"Issam D.","family":"Moussa","sequence":"additional","affiliation":[{"name":"Carle Heart and Vascular Institute, University of Illinois, Champagne (I.D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8234-3135","authenticated-orcid":true,"given":"Grant W.","family":"Reed","sequence":"additional","affiliation":[{"name":"Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (S.R.K., G.W.R., A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8336-3779","authenticated-orcid":true,"given":"Roger J.","family":"Laham","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (R.J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Morse","sequence":"additional","affiliation":[{"name":"Ascension Saint Thomas Hospital, Nashville, TN (M.A.M., E.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6266-9637","authenticated-orcid":true,"given":"Pedro","family":"Villablanca","sequence":"additional","affiliation":[{"name":"Structural Heart Disease Center, Henry Ford Hospital, Detroit, MI (P.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelio","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Ascension Saint Thomas Hospital, Nashville, TN (M.A.M., E.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-2649","authenticated-orcid":true,"given":"Jeremiah P.","family":"Depta","sequence":"additional","affiliation":[{"name":"Cardiovascular Disease Department, Sands-Constellation Heart Institute, Rochester, NY (J.P.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"McCabe","sequence":"additional","affiliation":[{"name":"University of Washington, Seattle (J.M.M.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2579-6434","authenticated-orcid":true,"given":"Vinayak N.","family":"Bapat","sequence":"additional","affiliation":[{"name":"Valve Science Center, Minneapolis Heart Institute Foundation, MN (V.N.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinod H.","family":"Thourani","sequence":"additional","affiliation":[{"name":"Piedmont Heart Institute, Atlanta, GA (P.Y., 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