Premium
Transcatheter aortic valve implantation for paradoxical low‐flow low‐gradient aortic stenosis patients
Author(s) -
Debry Nicolas,
Sudre Arnaud,
Amr Gilles,
Delhaye Cédric,
Schurtz Guillaume,
Montaigne David,
Koussa Mohamad,
Modine Thomas
Publication year - 2016
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26253
Subject(s) - medicine , stenosis , cardiology , ejection fraction , aortic valve stenosis , aortic valve , stroke volume , aortic valve replacement , heart failure
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 cm 2 /m 2 ) 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/m 2 , ejection fraction EF≥55%, valvuloarterial impedance Zva>4.5 mm Hg/mL/m 2 , maximal aortic jet velocity MaxV<4 m/s; LEF‐LG: MG≤40 mm Hg, MaxV<4 m/s, EF≤50%, SVI≤35 mL/m 2 ; and HGAS: MaxV>4 m/s, MG>40 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. © 2015 Wiley Periodicals, Inc.