Clinical Outcomes of Transcatheter Aortic Valve Replacement in Patients with Various Flow-Gradient and Ejection...

To compare the clinical outcomes of transcatheter aortic valve replace-ment (TAVR) for severe aortic stenosis (AS) in patients with different flow-gradient and left ventricular ejection fraction (EF) profiles.

Patients with severe AS who underwent TAVR with newer generation valves (Sapien3/3 Ultra, Evolut Pro/Pro+/FX) were retrospectively analyzed. Patients were divided into 5 groups: normal-flow high-gradient (NF-HG) AS (stroke volume index ≥ 35 mL/m2 and mean pressure gradient ≥ 40 mm Hg), low-flow high-gradient (LF-HG) with preserved EF (pEF, ≥ 50%), LF-HG with reduced EF (rEF), low-flow low-gradient (LF-LG) with pEF, and LF-LG with rEF.

A total of 846 patients were included in this study (NF-HG, n = 458; LF-HG with pEF, n = 142; LF-HG with rEF, n = 50; LF-LG with pEF, n = 113; LF-LG with rEF, n = 83). For the entire cohort, the median age was 82 years, and the periprocedural mortality rate was 2.1% with the highest rate in the LF-LG with rEF AS (7.2%). The 1-year and 5-year mortality rates were 13% and 51%, respectively. Multivariable Cox regression analysis showed higher all-cause mortality in the LF-HG with pEF (hazard ratio 1.42 [95% CI: 1.02-1.98]), LF-LG with pEF (1.84 [1.32-2.55]), and LF-LG with rEF (1.78 [1.22-2.61]) groups compared with the NF-HG group. Cardiovascular death rates were significantly higher in the LF-LG groups, but not in the LF-HG groups.

In addition to both LF-LG with pEF and rEF AS, LF-HG with pEF AS had a higher all-cause mortality rate after TAVR compared to NF-HG AS.