Impact of Flow-Gradient Patterns on Outcomes of Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis with Preserved Left Ventricular Ejection Fraction.
Yoshiyuki Yamashita, Massimo Baudo, Serge Sicouri, Mujtaba Zafar, Roberto Rodriguez, Eric M Gnall, Paul M Coady, Scott M Goldman, William A Gray, Basel Ramlawi
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引用次数: 0
Abstract
To compare the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) and preserved ejection fraction (pEF) according to flow-gradient status.This retrospective study focused on patients with severe AS and pEF (≥ 50%) undergoing TAVR with newer generation valves (Sapien3/3 Ultra, Evolut Pro/Pro+/FX) between 2018 and 2022 (n = 781). Patients were divided into 3 groups: normal-flow high-gradient (NF-HG, stroke volume index ≥ 35 mL/m2 and mean pressure gradient ≥ 40 mmHg or peak velocity ≥ 4 m/second), low-flow high-gradient (LF-HG), and paradoxical low-flow low-gradient (pLF-LG) groups. Multivariable Cox regression hazard model was used to adjust for confounders.There were 525, 188, and 68 patients in the NF-HG, LF-HG, and pLF-LG groups, respectively. For the entire cohort, the median age was 82 years, and the periprocedural, 1-year, and 5-year mortality rates were 1.8%, 12%, and 48%, respectively. During a median follow-up period of 25 (range 0-72) months, the rates of all-cause mortality and the composite of all-cause mortality and rehospitalization for heart failure were significantly higher in the LF-HG group compared with the NF-HG group, with adjusted hazard ratios (HRs) of 1.41 (95% confidence interval: 1.02-1.92) and 1.35 (1.01-1.79), respectively. In contrast, there were no significant differences between the LF-NG and pLF-LG groups.In patients undergoing TAVR for severe AS and pEF, LF-HG AS had a higher risk of all-cause mortality and the composite outcome compared with NF-HG AS.
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