1
|
Fusini L, Muratori M, Corrieri N, Capodaglio I, Tamborini G, Ghulam Ali S, Italiano G, Gripari P, Salvi L, Roberto M, Fabbiocchi F, Agrifoglio M, Bartorelli AL, Alamanni F, Pepi M. 624 Is TAVI a useful procedure in paradoxical low flow-low gradient aortic stenosis? A long-term mortality study. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Clinical outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG) undergoing valve replacement are controversial. PLF-LG is a combination of a small aortic valve area (AVA < 1cm²), a preserved left ventricular (LV) ejection fraction (LVEF≥50%), and a ‘paradoxical’ low mean gradient due to the presence of low LV stroke volume (≤35 mL/m²). The low flow state is explained by the presence of a high afterload and pronounced LV concentric remodeling, with impaired LV filling. Surgical aortic valve replacement has been associated with very positive outcomes in normal-flow high-gradient (NF-HG) AS, whereas poorer outcomes has been reported in patients with PLF-LG AS.
Purpose
The aim of this study is to determine the clinical outcomes in patients with PLF-LG AS undergoing transcatheter aortic valve implantation (TAVI) compare to NF-HG patients.
Methods
A total of 624 patients (age 81 ± 7 years) with symptomatic severe AS and preserved LVEF who underwent TAVI, was enrolled and divided in 2 groups: group NF-HG included 554 patients (89%) and group PLF-LG including 70 patients (11%). At 1-year follow-up, death and clinical events were reported.
Results
TAVI was feasible in all patients. A significant reduction in mean aortic pressure gradient was observed after TAVI both in PLF-LG (baseline, 30 ± 6 mmHg; 1-year, 12 ± 4 mmHg; p < 0.001) and in NF-HG (baseline, 55 ± 12 mmHg; 1-year, 11 ± 4 mmHg; p < 0.001) together with an increase in AVA (PLF-LG: baseline, 0.73 ± 0.16 cm², 1-year: 1.82 ± 0.43 cm², p < 0.001; NF-HG: baseline, 0.66 ± 0.18 cm², 1-year: 1.84 ± 0.38cm², p < 0.001). Perioperative mortality at 30-days was similar in group NF-HG (17/554, 3%) and in group PLF-LG (2/70, 3%). Figure shows the survival curves up to 5 years follow-up according to the two groups. PLF-LG and HG-AS had similar survival rate throughout the long-term follow-up. Similarly, rehospitalization rate was not different in the two groups (PLF-LG: 12% vs NF-HG: 7%, p = 0.127).
Conclusions
Differently from surgical series, TAVI in PLF-LG AS is a useful procedure showing similar mortality and rehospitalization rates compared to NF-HG AS patients.
Abstract 624 Figure. Survival curve
Collapse
Affiliation(s)
- L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - N Corrieri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - G Italiano
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Gripari
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Salvi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Roberto
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | | | | | - F Alamanni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
| |
Collapse
|