Flow Gradients in Severe Aortic Stenosis and Preserved Ejection Fraction: A 10-Year Transcatheter Aortic Valve...

There are limited and conflicting data on the long-term outcomes in normal-flow low-gradient (NFLG) and paradoxical low-flow low-gradient (pLFLG) aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR).

Patients who underwent TAVR for severe symptomatic native AS with preserved left ventricular ejection fraction (≥50%) from 2012 to 2022 at our center were included. The cohort was divided into 3 different hemodynamic AS groups: high-gradient aortic stenosis (HGAS) (aortic valve mean gradient [AVMG] ≥40 mm Hg, aortic valve [AV] peak velocity ≥4 m/s, and AV area ≤1 cm²), NFLG (stroke volume index ≥35 mL/m², AVMG <40 mm Hg, AV area ≤1 cm²), and pLFLG (stroke volume index <35 mL/m², AVMG <40 mm Hg, AV area ≤1 cm²). The primary outcome was all-cause mortality at 1 and 5 years.

Totally, 1683 patients (929 HGAS, 344 pLFLG, and 410 NFLG) were included; median age was 82.8 (77.2-87.2) years. At 1 year, mortality was higher among patients with pLFLG AS (15.5%) compared with HGAS (10.8%, P = .05). Although NFLG AS had a higher mortality than HGAS at 1 year, this did not reach statistical significance (15.9% vs 10.8%, respectively; P = .06). There was no significant difference in survival between the 3 groups at 5 years post-TAVR.

In patients who undergo TAVR, those with a pLFLG pattern of AS have a worse 1-year survival, but similar 5-year survival when compared with traditional HGAS AS. There was no significant difference in survival in patients with NFLG AS when compared with HGAS at 1 and 5 years post-TAVR.