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. 2018 Dec;31(6):849-860.
doi: 10.1111/joic.12561. Epub 2018 Sep 10.

Outcomes after transcatheter aortic valve replacement in patients with low versus high gradient severe aortic stenosis in the setting of preserved left ventricular ejection fraction

Binita Shah  1 , Daniel McDonald  2 , Darien Paone  2 , Gabriel Redel-Traub  2 , Umair Jangda  2 , Yu Guo  3 , Muhamed Saric  2 , Robert Donnino  1 , Cezar Staniloae  2 , Tonya Robin  2 , Ricardo Benenstein  2 , Alan Vainrib  2 , Mathew R Williams  4
Affiliations

Outcomes after transcatheter aortic valve replacement in patients with low versus high gradient severe aortic stenosis in the setting of preserved left ventricular ejection fraction

Binita Shah et al. J Interv Cardiol. 2018 Dec.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) for low gradient (LG) severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) remains an area of clinical uncertainty.

Methods: Retrospective review identified 422 patients who underwent TAVR between September 4, 2014 and July 1, 2016. Procedural indication other than severe AS (n = 22) or LVEF <50% (n = 98) were excluded. Outcomes were defined by valve academic research consortium two criteria when applicable and compared between LG (peak velocity <4.0 m/s and mean gradient <40 mmHg; n = 73) and high gradient (HG) (n = 229) groups. The LG group was further categorized as low stroke volume index (SVI) (n = 41) or normal SVI (n = 32). Median follow-up was 747 days [interquartile range 220-1013].

Results: Baseline thirty-day mortality risk (LG 6.2% [3.8-8.1] vs HG 5.7% [4.1-7.4], P = 0.43) did not differ between groups. Short-term outcomes, including procedural success rate (86.1% vs 88.8%, P = 0.53), peri-procedural complications (intra-procedural heart block: 6.8% vs 7.9%, P = 0.99; permanent pacemaker placement: 11.0% vs 13.6%, P = 0.69; moderate paravalvular regurgitation: 2.7% vs 1.3%, P = 0.60), and all-cause in-hospital mortality (2.7% vs 0.9%, P = 0.25) did not differ between LG and HG groups. On long-term follow-up, all-cause mortality also did not differ between LG and HG groups (6.8% vs 10.0%, plog-rank = 0.33) or between the LG low SVI (9.8%), LG normal SVI (3.1%), and HG (10.0%) groups (plog-rank = 0.39).

Conclusion: Patients with preserved LVEF undergoing TAVR for severe AS with LG, including LG with low SVI, have no significant difference in adverse outcomes when compared to patients with HG.

Keywords: aortic stenosis; transcatheter aortic valve replacement.

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Figures

FIGURE 1
FIGURE 1
Kaplan-Meier curves of all-cause mortality for patients with low (LG) versus high gradient (HG) severe aortic stenosis in the setting of normal left ventricular ejection fraction
FIGURE 2
FIGURE 2
Kaplan-Meier curves of all-cause mortality for patients with low gradient (LG) low stroke volume index (SVI), LG normal SVI, and high gradient (HG) severe aortic stenosis in the setting of normal left ventricular ejection fraction
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References

    1. Otto CM, Prendergast B. Aortic-valve stenosis—from patients at risk to severe valve obstruction. N Engl J Med. 2014;371:744–756. - PubMed
    1. Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P. Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007;115:2856–2864. - PubMed
    1. Clavel MA, Dumesnil JG, Capoulade R, Mathieu P, Senechai M, Pibarot P. Outcome of patients with aortic stenosis, small valve area, and low-flow, low-gradient despite preserved left ventricular ejection fraction. J Am Coll Cardiol. 2012;60:1259–1267. - PubMed
    1. Mohty D, Magne J, Deltreuil M, et al.Outcome and impact of surgery in paradoxical low-flow, low-gradient severe aortic stenosis and preserved left ventricular ejection fraction: a cardiac catheterization study. Circulation. 2013;128:S235–S242. - PubMed
    1. Clavel MA, Burwash IG, Pibarot P. Cardiac imaging for assessing low-gradient severe aortic stenosis. JACC: Cardiovascular Imaging. 2017;10:185–202. - PubMed

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