Is it really "paradoxical" or just the ventricle?

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Paradoxical low flow low gradient aortic stenosis (PLFLG AS) presents a unique clinical challenge.
• Transcatheter aortic valve replacement (TAVR) is an increasingly utilized treatment for aortic stenosis.
• Outcomes in PLFLG AS patients undergoing TAVR require further elucidation compared to high gradient AS (HGAS).

Discussion:

• Mid-term outcomes for PLFLG AS patients after TAVR are favorable and comparable to HGAS patients.
• Delayed referral for valve intervention in PLFLG AS may negatively impact patient outcomes.
• Current data suggests TAVR is a viable option for PLFLG AS, challenging previous assumptions.

Key Insights:

• TAVR demonstrates comparable mid-term efficacy in PLFLG AS and HGAS.
• Prompt consideration for TAVR or SAVR in PLFLG AS is clinically indicated.
• PLFLG AS patients benefit from timely valve replacement, irrespective of gradient severity.

Outlook:

• Further research is needed to address the observed higher early mortality in PLFLG AS post-TAVR.
• Investigating TAVR procedural refinements may improve outcomes for PLFLG AS patients.
• Long-term comparative studies of TAVR versus SAVR in PLFLG AS are warranted.