Abstract 11823: Low Preprocedural Transvalvular Gradient Predicts Cardiovascular Mortality Following Tavi: Insights From the France 2 Registry
Introduction: Transaortic valve implantation (TAVI) has emerged as a viable alternative to conventional aortic valve replacement for selected patients. Although the technique is expanding, relatively little is known about the impact of pre-procedural aortic transvalvular gradient on cardiovascular outcomes, as this potential relationship was not studied on large patients samples. Hypothesis: We assessed the hypothesis that presence of a pre-procedural low (<40 mmHg) mean trans-aortic gradient (MTG) could predict cardiovascular mortality following TAVI.
Methods: We studied highly symptomatic patients with high risk for surgery who underwent TAVI in the FRANCE 2 national multicenter French registry. The primary endpoint was incidence of any cardiovascular death (fatal heart failure, myocardial infarction, stroke, pulmonary embolism, arrhythmia, or high-grade atrio-ventricular conduction disorder) in the year following the procedure. We used a univariate Cox model to analyze 1-year survival data, with a P value of less than 0.2 indicating statistical significance. In a second place, we entered the variables significantly associated with adverse events during the follow-up period in a multivariate Cox model with stepwise regression.
Results: A total of 3195 patients (age= 82.7±7.2 years; 49% women; Euroscore= 21.8±14.3) were enrolled in the study. Low MTG (<40 mmHg) was present in 23.2% of the subjects and the mean left ventricular ejection fraction (LVEF) was 55.5±12.6%. Cardiovascular death occurred in 14.3% of the subjects. The cardiovascular survival was significantly lower in patients with baseline low MTG compared to the others (86.4 % vs. 92.4 %, p<0.001 by log rank analysis). Multivariate analysis revealed that low MTG (HR=1.6 [1.2-2.1], p<0.001) predicted cardiovascular death independently of baseline left ventricle ejection fraction and after adjustment for other confounding predictive factors.
Conclusion: Presence of a low MTG (<40 mmHg) prior to TAVI was associated with a greater risk of cardiovascular death, up to 1 year following the procedure. Pre-procedural MTG could be used to identify patients at a high risk for adverse cardiovascular outcomes following TAVI.
- © 2012 by American Heart Association, Inc.