Intervention Versus Observation in Symptomatic Patients With Normal Flow Low Gradient Severe Aortic Stenosis

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Severe symptomatic aortic stenosis (AS) is a critical condition with high mortality.
• Treatment guidelines for AS with normal flow and low gradients are not well-defined.
• Distinguishing between low-flow/low-gradient and normal-flow/low-gradient AS is crucial for management.

Purpose of the Study:

• To describe patients with severe symptomatic aortic stenosis presenting with normal flow and low gradients.
• To evaluate the benefit of aortic valve intervention (SAVR or TAVR) versus conservative management in this patient group.

Main Methods:

• Retrospective analysis of adult patients with AS (aortic valve area ≤1.0 cm², mean gradient <40 mm Hg, stroke volume index >35 ml/m²) and symptoms between 2012-2015.
• Patients underwent either surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR), or conservative treatment.
• Endpoints included all-cause mortality and cardiac-related mortality, with follow-up of 652 days.

Main Results:

• Out of 1,358 identified patients, 303 met criteria for normal flow/low gradient AS.
• Overall mortality was significantly lower in TAVR (10%) and SAVR (12%) groups compared to conservative treatment (28%) (p < 0.001).
• TAVR was associated with improved survival (HR 0.49) and reduced cardiac mortality (HR 0.30) versus conservative care. SAVR showed no significant difference compared to TAVR.

Conclusions:

• Symptomatic patients with severe AS, normal flow, and low gradients may benefit from intervention.
• Aortic valve intervention, particularly TAVR, offers improved survival outcomes compared to conservative management in this specific AS subgroup.