P4227Role of contractile reserve as a predictor of mortality in low-flow, low-gradient severe aortic stenosis patients following transcatheter aortic valve replacement

Low-flow low-gradient severe aortic stenosis (LFLGAS) is associated with worse outcomes. Aortic valve calcification patterns of LFLGAS as compared to non-LFLGAS have not yet been thoroughly assessed. 137 patients undergoing transcatheter aortic valve replacement (TAVR) with preprocedural multidetector computed tomography (MDCT) and postprocedural transthoracic echocardiography were enrolled. Calcification characteristics were assessed by MDCT both for the total aortic valve and separately for each leaflet. 34 patients had LFLGAS and 103 non-LFLGAS. Total aortic valve calcification volume (p<0.001), mass (p<0.001), and density (p=0.004) were lower in LFLGAS as compared to non-LFLGAS patients. At 30-day follow-up, mean transaortic pressure gradients and more than mild paravalvular regurgitation did not differ between groups. In conclusion, LFLGAS and non-LFLGAS express different calcification patterns which, however, did not impact on device success after TAVR.

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Transcatheter Aortic Valve Replacement (TAVR) in Low Flow-Low Gradient Severe Aortic Stenosis without Cardiac Reserve

Journal of Advanced Therapies and Medical Innovation Sciences ◽

10.17987/jatamis.v2i0.392 ◽

2017 ◽

Vol 2 ◽

Author(s):

Anuraj Sudhakaran ◽

Mahek Shah ◽

Aparna Baburaj ◽

Brijesh Patel ◽

Matthew Martinez ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Low Flow ◽

Left Ventricular Ejection ◽

Contractile Reserve ◽

Transcatheter Aortic Valve

With accumulating positive evidence in favour of transcatheter aortic valve replacement (TAVR) over a surgical approach, it has replaced surgical AVR to become the mainstay of treatment for severe symptomatic aortic stenosis in patients with prohibitive and high surgical risk. There is significant surgical mortality and morbidity associated with surgical aortic valve replacement in patients with low flow-low gradient (LFLG) true severe aortic valve stenosis (AS) and severely reduced left ventricular ejection fraction (rEF) without contractile reserve (CR). CR is measured following use of dobutamine in an attempt to increase cardiac output by more than 20% while differentiating severe from pseudostenosis in some cases. The value of transcatheter aortic valve replacement (TAVR) over a surgical approach for these patients with rEF LFLG true severe AS and no CR is uncertain. We present a patient with LFLG severe AS and low left ventricular EF without contractile reserve who underwent TAVR and experienced significant improvement in their clinical status without complications.

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Characteristics and outcome following transcatheter aortic valve replacement in patients with severe aortic stenosis with low flow

EuroIntervention ◽

10.4244/eij-d-17-00139 ◽

2017 ◽

Vol 13 (12) ◽

pp. e1428-e1435 ◽

Cited By ~ 8

Author(s):

Yigal Abramowitz ◽

Tarun Chakravarty ◽

Philippe Pibarot ◽

Yoshio Maeno ◽

Hiroyuki Kawamori ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Low Flow ◽

Transcatheter Aortic Valve

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Faculty Opinions recommendation of Transcatheter aortic-valve replacement for inoperable severe aortic stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14267125.15779289 ◽

2012 ◽

Author(s):

Ulrich Sigwart ◽

Amir-Ali Fassa

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve

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Faculty Opinions recommendation of Transcatheter aortic-valve replacement for inoperable severe aortic stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14267125.793480533 ◽

2013 ◽

Author(s):

Bernard Prendergast

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve

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True-severe stenosis in paradoxical low-flow low-gradient aortic stenosis: outcomes after transcatheter aortic valve replacement

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcab010 ◽

2021 ◽

Author(s):

Taishi Okuno ◽

Noé Corpataux ◽

Giancarlo Spano ◽

Christoph Gräni ◽

Dik Heg ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Functional Status ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Low Flow ◽

Aortic Valve Area ◽

High Gradient ◽

Transcatheter Aortic Valve

Abstract Aims The ESC/EACTS guidelines propose criteria that determine the likelihood of true-severe aortic stenosis (AS). We aimed to investigate the impact of the guideline-based criteria of the likelihood of true-severe AS in patients with low-flow low-gradient (LFLG) AS with preserved ejection fraction (pEF) on outcomes following transcatheter aortic valve replacement (TAVR). Methods and results In a prospective TAVR registry, LFLG-AS patients with pEF were retrospectively categorized into high (criteria ≥6) and intermediate (criteria <6) likelihood of true-severe AS. Haemodynamic, functional, and clinical outcomes were compared with high-gradient AS patients with pEF. Among 632 eligible patients, 202 fulfilled diagnostic criteria for LFLG-AS. Significant haemodynamic improvement after TAVR was observed in LFLG-AS patients, irrespective of the likelihood. Although >70% of LFLG-AS patients had functional improvement, impaired functional status [New York Heart Association (NYHA III/IV)] persisted more frequently at 1 year in LFLG-AS than in high-gradient AS patients (7.8%), irrespective of the likelihood (high: 17.4%, P = 0.006; intermediate: 21.1%, P < 0.001). All-cause death at 1 year occurred in 6.6% of high-gradient AS patients, 10.9% of LFLG-AS patients with high likelihood [hazard ratio (HR)adj 1.43, 95% confidence interval (CI) 0.68–3.02], and in 7.2% of those with intermediate likelihood (HRadj 0.92, 95% CI 0.39–2.18). Among the criteria, only the absence of aortic valve area ≤0.8 cm2 emerged as an independent predictor of treatment futility, a combined endpoint of all-cause death or NYHA III/IV at 1 year (OR 2.70, 95% CI 1.14–6.25). Conclusion Patients with LFLG-AS with pEF had comparable survival but worse functional status at 1 year than high-gradient AS with pEF, irrespective of the likelihood of true-severe AS. Clinical Trial Registration https://www.clinicaltrials.gov. NCT01368250.

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