Open AccessOutcomes after transcatheter aortic valve replacement in patients with low versus high gradient severe aortic stenosis in the setting of preserved left ventricular ejection fraction
Author(s) -
Shah Binita,
McDonald Daniel,
Paone Darien,
RedelTraub Gabriel,
Jangda Umair,
Guo Yu,
Saric Muhamed,
Donnino Robert,
Staniloae Cezar,
Robin Tonya,
Benenstein Ricardo,
Vainrib Alan,
Williams Mathew R.
Publication year - 2018
Publication title -
journal of interventional cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.764
H-Index - 51
eISSN - 1540-8183
pISSN - 0896-4327
DOI - 10.1111/joic.12561
Subject(s) - medicine , ejection fraction , interquartile range , cardiology , stenosis , aortic valve stenosis , stroke volume , aortic valve replacement , aortic valve , heart failure
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%, p log‐rank = 0.33) or between the LG low SVI (9.8%), LG normal SVI (3.1%), and HG (10.0%) groups (p log‐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.