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Transcatheter aortic valve replacement outcomes in patients with low-flow very low-gradient aortic stenosis

Hiroki A Ueyama1,2,3, Lakshay Chopra1,2, Ankur Dalsania1

  • 1Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029, USA.

European Heart Journal. Cardiovascular Imaging
|September 29, 2023
PubMed

Insights

Patients with severe aortic stenosis and very low-flow low-gradient (LG) have worse outcomes. Transcatheter aortic valve replacement (TAVR) did not show benefit in this distinct population, indicating a need for further research.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Severe aortic stenosis (AS) with low-flow low-gradient (LG) is associated with poor prognosis.
  • Very low-flow LG (mean pressure gradient ≤ 20 mmHg) may indicate a unique patient subgroup with advanced cardiac dysfunction.

Purpose of the Study:

  • To characterize patients with very low-flow LG severe AS.
  • To evaluate the clinical outcomes and TAVR benefit in this specific AS population.

Main Methods:

  • Single-center retrospective study of 662 patients with low-flow severe AS (2019-2021).
  • Patients categorized into very LG (MPG ≤ 20 mmHg), LG (20 < MPG < 40 mmHg), and high-gradient (HG) (MPG ≥ 40 mmHg) groups.
  • Comparison of composite endpoint (all-cause mortality, heart failure rehospitalization) between groups and after TAVR versus conservative management.

Main Results:

  • The very LG cohort (20%) exhibited higher comorbidities and lower LVEF (45%) compared to LG (51%) and HG (29%) groups.
  • A graded increase in adverse events was observed with decreasing MPG.
  • In TAVR recipients, very LG was an independent predictor of adverse outcomes (aHR 2.42).
  • TAVR reduced adverse events in LG and HG groups but not in the very LG group (aHR 0.69).

Conclusions:

  • Very low-flow LG severe AS defines a distinct patient group with substantial comorbidities and poorer outcomes.
  • Transcatheter aortic valve replacement (TAVR) does not appear to confer a survival or rehospitalization benefit in this specific subgroup.
  • Further research is required to ascertain the optimal management strategy and TAVR efficacy in patients with very low-flow LG severe AS.
Abstract

Keywords:
aortic valve replacementlow-gradient aortic stenosistranscatheter aortic valve replacement

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