Transcatheter aortic valve implantation for paradoxical low‐flow low‐gradient aortic stenosis patients
- 1 October 2015
- journal article
- research article
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 87 (4) , 797-804
Abstract
Objectives: We compared the outcomes of transcatheter aortic valve implantation (TAVI) in three different aortic stenosis syndromes: paradoxical low‐flow low‐gradient aortic stenosis (PLFLG), high‐gradient aortic stenosis (HGAS), and low ejection fraction low‐gradient severe aortic stenosis (LEF‐LG).Background: Outcomes for PLFLG patients after TAVI procedure are not well known.Methods: Between 2010 and 2013, patients with severe (indexed aortic valve area iAVA≤0.6 cm2/m2) symptomatic aortic stenosis were consecutively referred to our institution for TAVI because of multiple comorbidities and excessive surgical risk. About 262 patients were split into three groups as following, PLFLG: mean gradient MG≤40 mm Hg, stroke volume index SVI≤35 mL/m2, ejection fraction EF≥55%, valvuloarterial impedance Zva>4.5 mm Hg/mL/m2, maximal aortic jet velocity MaxV40 mm Hg, EF>55%. The primary endpoint of our study was to evaluate mid‐term global and cardiovascular mortalities; secondary endpoints included recommended VARC‐2 variables.Results: PLFLG (n = 31) mid‐term survival was similar to HGAS (n = 172) (mean follow‐up = 13.2 months [4.6–26]). Conversely LEF‐LG patients (n = 59) displayed significant higher rates of all‐cause (P = 0.01) and cardiovascular mortalities (P = 0.05). Postprocedural outcomes (VARC‐2 criteria) were similar in the PLFLG and HGAS groups except regarding major bleeding (P = 0.02), while the LEF‐LG group had more congestive heart failure and a higher BNP before discharge (both P < 0.001) than the other groups. 30‐days deaths were significantly more frequent in LEF‐LG and PLFLG in comparison to HGAS (P = 0.03).Conclusion: As opposed to LEF‐LG patients, mid‐term prognosis after TAVI procedure in PLFLG patients is similar to HGAS patients despite higher perioperative mortality.Keywords
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