Chang Y; The First Hospital of Hebei Medical
University, Shijiazhuang, Hebei, China.
Li L; Ma Y; Zhou J; Wang L; Zhan Y

Catheterization & Cardiovascular Interventions. 107(5):1369-1375, 2026

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.