Valvular heart diseaseComparison of Outcome of Higher Versus Lower Transvalvular Gradients in Patients With Severe Aortic Stenosis and Low (<40%) Left Ventricular Ejection Fraction
Section snippets
Methods
From April 2007 to December 2010, 890 consecutive patients with severe symptomatic AS, defined as aortic valve area <1 cm2 or aortic valve index <0.5 cm2/m2, who were referred for participation in a randomized TAVI trial (Placement of Aortic Transcatheter Valves [PARTNER]) were prospectively entered into a dedicated database and thus considered for this analysis. All patients were screened and gave written consent for the study. Those with severe AS (aortic valve area <1 cm2 or aortic valve
Results
Baseline clinical characteristics of low- and high-gradient patients are listed in Table 1. Those with low gradients were younger by 4 years (p <0.001) and more often had coronary heart disease, as evidenced by more previous myocardial infarctions (p = 0.01) and coronary bypass surgery (p <0.001). They also more often had renal insufficiency (p = 0.03).
Table 2 compares the echocardiographic and hemodynamic measurements of the 2 groups. Aortic valve area was larger (p <0.001), while the EF and
Discussion
Our study confirms the limited life expectancy of patients (overall mortality of 50% at 2 years) who present with severe AS and depressed left ventricular function, who are at high risk for SAVR. In particular, the results of the study demonstrate the adverse prognostic implications of patients presenting with low transvalvular gradients (<40 mm Hg), who experienced an even higher mortality rate compared to patients with higher transvalvular gradients.
A similar adverse prognostic impact of a
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Transcatheter aortic valve implantation outcomes in patients with low flow low gradient aortic stenosis
2022, Revista Portuguesa de CardiologiaComparison of Benefit of Transcatheter Aortic Valve Implantation in Patients With Low Gradient Versus High Gradient Aortic Stenosis and Left Ventricular Dysfunction
2020, American Journal of CardiologyCitation Excerpt :In accordance with multiple prior studies, the present study shows that significant improvements in LVEF can be achieved with TAVI in LG-AS patients. Importantly, TAVI has previously been found to result in faster improvements in LVEF when compared to SAVR,5,20 which is noteworthy in LG-AS patients with prohibitive surgical risk. However, conflicting findings have been reported in prior literature with regard to improvements in LVEF.
Intraprocedural invasive hemodynamic parameters as predictors of short- and long-term outcomes in patients undergoing transcatheter aortic valve replacement
2018, Cardiovascular Revascularization MedicineCitation Excerpt :However, per the multivariate logistic model, the preprocedural transaortic pressure gradient and ≥ moderate MR were found to have trends toward positive and negative associations, respectively, with CI improvement; and baseline ≥ moderate RV dysfunction and invasive PASP were both found to have no association with CI improvement. Our predictors for cardiac index improvement are largely in line with previously published studies [3,8,9,17]. The findings of this study suggest that the assessment of post-valve implant cardiac index is useful in evaluating the immediate hemodynamic benefit of TAVR and in predicting the risk of early and late mortality.
Transcatheter Aortic Valve Replacement in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The TOPAS-TAVI Registry
2018, Journal of the American College of CardiologyCitation Excerpt :Although there is no definite explanation for such differences, the avoidance of extracorporeal circulation and a lower degree of myocardial injury may have contributed to the improved outcomes. In fact, previous studies showed a more rapid recovery of LVEF in patients with reduced ventricular function undergoing TAVR (vs. SAVR) (19,20), and a significant improvement in LVEF was also observed in our study within the few days following the procedure. However, up to ∼6% of the patients required some hemodynamic support post-TAVR, and this is in accordance with prior TAVR studies in LFLG-AS patients (17,30).
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2017, Journal of the American College of CardiologyCardiac Imaging for Assessing Low-Gradient Severe Aortic Stenosis
2017, JACC: Cardiovascular Imaging