, Massimo Baudo 1
, Serge Sicouri 1
, Roberto Rodriguez 2
, Eric M. Gnall 3
, Paul M. Coady 3
, Scott M. Goldman 2
, William A. Gray 3
, Basel Ramlawi 4
2Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
3Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health Wynnewood, Pennsylvania, USA
4Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health Wynnewood, Pennsylvania, USA;Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
Abstract
Background: To compare the clinical outcomes of transcatheter aortic valve replace-ment (TAVR) for severe aortic stenosis (AS) in patients with different flow-gradient and left ventricular ejection fraction (EF) profiles.
Methods: Patients with severe AS who underwent TAVR with newer generation valves (Sapien3/3 Ultra, Evolut Pro/Pro+/FX) were retrospectively analyzed. Patients were divided into 5 groups: normal-flow high-gradient (NF-HG) AS (stroke volume index ≥ 35 mL/m2 and mean pressure gradient ≥ 40 mm Hg), low-flow high-gradient (LF-HG) with preserved EF (pEF, ≥ 50%), LF-HG with reduced EF (rEF), low-flow low-gradient (LF-LG) with pEF, and LF-LG with rEF.
Results: A total of 846 patients were included in this study (NF-HG, n = 458; LF-HG with pEF, n = 142; LF-HG with rEF, n = 50; LF-LG with pEF, n = 113; LF-LG with rEF, n = 83). For the entire cohort, the median age was 82 years, and the periprocedural mortality rate was 2.1% with the highest rate in the LF-LG with rEF AS (7.2%). The 1-year and 5-year mortality rates were 13% and 51%, respectively. Multivariable Cox regression analysis showed higher all-cause mortality in the LF-HG with pEF (hazard ratio 1.42 [95% CI: 1.02-1.98]), LF-LG with pEF (1.84 [1.32-2.55]), and LF-LG with rEF (1.78 [1.22-2.61]) groups compared with the NF-HG group. Cardiovascular death rates were significantly higher in the LF-LG groups, but not in the LF-HG groups.
Conclusion: In addition to both LF-LG with pEF and rEF AS, LF-HG with pEF AS had a higher all-cause mortality rate after TAVR compared to NF-HG AS.