Transcatheter Aortic Valve Implantation in Very Low-Gradient Aortic Stenosis

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Severe aortic stenosis poses a significant clinical challenge.
• Transcatheter aortic valve implantation (TAVI) is established for low-gradient aortic stenosis (LGAS).
• Outcomes of TAVI in very low-gradient aortic stenosis (VLGAS) remain less understood.

Purpose of the Study:

• To evaluate the efficacy and outcomes of TAVI in patients with VLGAS.
• To compare TAVI outcomes across different gradient and flow subgroups in severe aortic stenosis.
• To assess symptom and quality-of-life improvement, rehospitalization, and mortality post-TAVI.

Main Methods:

• Retrospective cohort study of 1173 patients undergoing TAVI for severe aortic stenosis.
• Patients classified into VLGAS (MPG ≤25 mmHg), LGAS (25-40 mmHg), and high-gradient (≥40 mmHg) groups.
• Subgroup analysis based on classical low-flow, paradoxical low-flow, and normal flow states.

Main Results:

• TAVI led to symptom and quality-of-life improvements in most VLGAS patients.
• A significant decrease in symptom improvement was noted at 1-year in VLGAS patients (p < 0.01).
• VLGAS patients experienced the highest 1-year rehospitalization rates (p < 0.01); other outcomes were similar across groups.

Conclusions:

• TAVI effectively improves symptoms and quality of life in LGAS, including VLGAS patients.
• Symptom improvement diminishes at 1-year in VLGAS, particularly in normal flow subgroups.
• Mortality and rehospitalization differences were primarily observed in classical low-flow VLGAS subgroups.