Effect of low-flow, very low-gradient aortic stenosis on survival and objective functional recovery after TAVI

It is unclear how the magnitude of reductions in baseline mean aortic gradient and flow affects clinical outcomes after TAVI. This study aimed to assess the prognostic impact of low-flow very low-gradient (LF-VLG) aortic stenosis on survival and objective functional recovery after TAVI.

Data from the Spanish TAVI Registry were analyzed. Three groups were included: high-gradient (≥ 40 mmHg), low-flow low-gradient (LF-LG) (20-39 mmHg) and LF-VLG (≤ 20 mmHg). A prospective single-center substudy was conducted to evaluate objective functional recovery after TAVI.

A total of 17 836 patients were included. Two-year survival was 82% in the high-gradient group (n = 12 800), 79% in the LF-LG group (n = 4126), and 73.2% in the LF-VLG group (n = 495) (P < .0001). In patients with LF-VLG, coronary artery disease and atrial fibrillation, but not ejection fraction, independently predicted mortality. In a cohort of 465 patients, objective improvement was observed in 88% of patients in the high-gradient group, 70% in the LF-LG group, and 57% in the LF-VLG group (P < .0001).

Patients with LF-VLG aortic stenosis show reduced but acceptable 2-year survival regardless of ejection fraction and limited functional recovery at 6 months after TAVI. Coronary artery disease and atrial fibrillation were independent predictors of mortality.