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Impact of flow, gradient, and left ventricular function on outcomes after transcatheter aortic valve replacement
Author(s) -
Carreras Edward T.,
Kaneko Tsuyoshi,
RamirezDel Val Fernando,
Pelletier Marc P.,
Sobieszczyk Piotr S.,
Bhatt Deepak L.,
Shah Pinak B.
Publication year - 2018
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.27347
Subject(s) - medicine , ejection fraction , cardiology , stroke volume , valve replacement , heart failure , stroke (engine) , stenosis , mechanical engineering , engineering
Objectives To assess the impact of low flow with and without preserved left ventricular ejection fraction (LVEF) on outcomes after transcatheter aortic valve replacement (TAVR). Background Prior studies have shown that patients with low flow, AVG, and LVEF have worse outcomes after TAVR. It is unclear whether low AVG and LVEF remain prognostic after adjusting for flow, and how the outcomes of patients with low flow with and without preserved LVEF compare after TAVR. The goal of this study was to provide insight into these open questions. Methods Data from 340 TAVR patients at Brigham and Women's Hospital from 2011 through 2015 were analyzed. Low flow was defined as stroke volume index (SVI) ≤35 mL/m 2 , low AVG as mean gradient < 40 mmHg, and reduced LVEF as < 50%. Results Low flow was present in 96 (28.2%) patients, 48 (50.0%) of whom also had reduced LVEF. At 1 year, low flow was associated with increased mortality (21.9 vs 7.4%; P = 0.0002) and heart failure (HF) (20.8 vs 5.3%; P = 0.0113). Among patients with low flow, those with preserved LVEF had increased mortality (HR 5.17, 95% CI 2.73‐9.80; P < 0.001) and HF (HR 7.69, 95% CI 3.86‐15.31; P < 0.001). After adjusting for clinical factors, patients with low flow had increased mortality (HR 6.51, 95% CI 2.98‐14.22; P < 0.001) and HF (HR 5.52, 95% CI 2.34‐12.98; P < 0.001), while neither low AVG nor low LVEF were associated with increases in mortality or HF. Conclusions In patients undergoing TAVR, low flow was an independent predictor of 1‐year mortality and HF, and a stronger predictor than either low AVG or LVEF. Patients with low flow and preserved EF had increased mortality and HF at 1‐year, while those with low flow and reduced EF had outcomes similar to patients with normal flow.