Outcome of Patients with Low-Gradient Aortic Stenosis Undergoing Transcatheter or Surgical Aortic Valve Replacement

Patients with low-gradient (LG) severe aortic stenosis (AS) have worse outcome following surgical aortic valve replacement (SAVR) than patients with high-gradient AS. We hypothesized that transcatheter aortic valve replacement (TAVR) may be a better treatment option for these patients. The aim of this study was to compare outcomes of patients with LG AS referred for TAVR and SAVR.

We analysed clinical, echocardiographic and outcome data in 50 consecutive patients (age 81 ± 6 years, 50% females) with LG AS (aortic valve area ≤ 1 cm², mean aortic valve pressure gradient <40 mmHg and peak aortic jet velocity < 4 m/s) who underwent TAVR, and compared them with 80 patients (age 76 ± 7 years, 35% females) who underwent SAVR.

Over 4 years of follow-up there was no difference in survival free of stroke, long-term dialysis or urgent rehospitalization and overall survival between patients undergoing TAVR or SAVR (12% and 61% vs. 19% and 67%, p = 0.9 and 0.8, respectively), even though TAVR patients were significantly older, had more comorbidities and had a higher EuroSCORE II. After adjustment for these covariates, TAVR was associated with better event-free survival (adjusted HR: 0.63, 95% CI 0.40-0.97, p = 0.044).

Patients with LG AS had better adjusted event-free survival when referred to TAVR rather than to SAVR.

Symptomatic patients with low-gradient severe aortic stenosis are at high risk for surgical aortic valve replacement. In this study, Transcatheter, as compared to surgical aortic valve replacement, was associated with better adjusted event free survival in patients with low gradient aortic stenosis.