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With accumulating positive evidence in favour of transcatheter aortic valve replacement (TAVR) over a surgical approach , it has replaced surgical AVR to become the mainstay of treatment for severe symptomatic aortic stenosis in patients with prohibitive and high surgical risk. There is significant surgical mortality and morbidity associated with surgical aortic valve replacement in patients with low flow-low gradient (LFLG) true severe aortic valve stenosis (AS) and severely reduced left ventricular ejection fraction (rEF) without contractile reserve (CR). CR is measured following use of dobutamine in an attempt to increase cardiac output by more than 20% while differentiating severe from pseudostenosis in some cases. The value of transcatheter aortic valve replacement (TAVR) over a surgical approach for these patients with rEF LFLG true severe AS and no CR is uncertain. We present a patient with LFLG severe AS and low left ventricular EF without contractile reserve who underwent TAVR and experienced significant improvement in their clinical status without complications.

Transcatheter Aortic Valve Replacement (TAVR) in Low Flow-Low Gradient Severe Aortic Stenosis without Cardiac Reserve