Abstract 13401: Clinical Outcome after Transfemoral Aortic Valve Replacement in Patients with Low-Gradient Aortic Stenosis in Local Anesthesia
Objectives The aim of this study was to evaluate clinical outcome after CoreValve implantation in patients (pts) with low-gradient aortic stenosis (LGAS). We were especially interested in the 30 days mortality and in longterm outcome in respect to the presence or absence of contractile reserve (CR) evaluated by low dose dobutamine stessechocardiography (LDSE). Background Pts with LGAS have a considerable high operative mortality, especially if pts show no CR during LDSE. Percutaneous aortic valve repair (TAVI) is a new emerging technology for interventional treatment of severe aortic valve stenosis in surgical high-risk patients and offers a less invasive approach in these pts. Hence one might speculate that TAVI represents a promising treatment for these patients.
Methods From April 2010 to february 2012 in total 165 patients (age 80.6 +0.8 years ) with high perioperative risk (log Euroscore > 20%) underwent TAVI at our hospital using the CoreValve Revalving system (26/29/31mm) in local anesthesia. Of these pts , 25 (15.2%) pts suffered from LGAS [aortic valve area > 1 cm2, mean pressure gradient > 40 mmHG, left ventricular ejection fraction (LVEF) > 40% . Pts with LGAS and without CR were scheduled to balloon valvuloplasty and only refered to TAVI if the left ventricular ejection fraction or the clinical status improved in these pts. The CoreValve prothesis was inserted retrograde by 18 F sheath. Patients were followed up clinically and by echocardiography.
Results The all-cause longterm mortality in patients with LGAS (log Euroscore 32.2 ± 2.6 %, LVEF 32.7 ±1.4 , mean aortic gradient 29.6 ± 1.3 mmHg) compared to patient without LGAS ( log Euroscore 22.6 ±1.0 %, LVEF 53.9 ±0.7 , mean aortic gradient 46.9 ±1.2 mmHg) were higher (28% versus 12.1 %, p=0.05) but obviosly better than the reported mortalities in conventional surgical series. The absence of CR in pts with LGAS scheduled for TAVI is also associated with a poor prognosis (all-cause longterm mortality 40%).
Conclusion TAVI represents a feasible option for patients with LGAS although the mortality is higher compared to patients without LGAS but better than after conventional surgical replacement.The lack of CR in these patients results also in a poorer longterm prognosis
- © 2012 by American Heart Association, Inc.