Prognostic relevance of persistently low transvalvular flow rate after transcatheter aortic valve replacement in a...

Transvalvular flow rate (FR), defined as stroke volume divided by ejection time, is an important prognostic parameter in transcatheter aortic valve replacement (TAVR) patients. The prognostic implications of post-TAVR FR remain unclear, particularly in non-Western populations. We investigated the prognostic relevance of FR after TAVR in a Japanese population.

We retrospectively analyzed 499 consecutive patients with severe aortic stenosis (AS) who underwent TAVR between 2014 and 2022. Patients were classified into three groups based on pre- and post-TAVR FR measured with transthoracic echocardiography: Normal FR (pre-FR ≥ 200 mL/s, N = 253), Recovered FR (pre-FR < 200 and post-FR ≥ 200, N = 112), and Persistently low FR (pre-FR < 200 and post-FR < 200, N = 134) group. All cause death- and heart failure (HF) readmission-free survival rate after TAVR were compared among the groups.

The mean age and BSA of participants were 84.1 ± 5.0 years and 1.45 ± 0.17 m², and 64% were female. Thirty-eight all-cause deaths and 35 HF readmissions occurred within 2 years after TAVR. Patients in the Persistently low FR group had significantly more HF readmission than those in the Normal FR or Recovered FR groups (Log rank P < 0.001), whereas the all-cause death-free survival rate was similar among the three groups. Cox-Hazard multivariate analysis demonstrated that atrial fibrillation, chronic kidney disease, anemia, and persistently low FR were independent predictors of future HF readmission after TAVR (hazard ratio of persistently low FR = 2.38, P = 0.047).

AS patients with persistently low FR even after TAVR had a higher rate of HF hospital-readmissions in a Japanese cohort.