Decoding High Post-TAVR Gradients

Echocardiography is a well-established tool for evaluating bioprosthetic valve performance after transcatheter aortic valve replacement. The presence of higher-than-expected echocardiographic gradients is not an uncommon finding and can be related to different clinical settings. This case series proposes a practical and multiparametric approach to interpreting high residual gradients after transcatheter aortic valve replacement. We examine 4 common clinical scenarios: 1) pressure recovery; 2) high-flow state; 3) prosthesis–patient mismatch; and 4) suboptimal valve expansion. For each scenario, a comprehensive echocardiographic analysis, along with invasive hemodynamic evaluation, is reported.