Abstract 10894: Clinical Outcome After Transfemoral Aortic Valve Replacement (TAVI) in Patients With Low-gradient , Paradoxical Low-flow Aortic Stenosis And High-gradient Aortic Stenosis In Local Anesthesia
Background: Conventional aortic valve replacement in pts with low-gradient (LGAS) or paradoxical low-flow aortic (PLFAS) stenosis is associated with a high peri- and postoperative mortality. TAVI might represent an alternative treatment option for these pts with LGAS/PLFAS.
Aim of the study:
The aim of this study was to investigate the clinical outcome of TAVI in pts with LGAS or PLFAS in comparison to high-gradient aortic stenosis (HGAS).
Methods: From April 2010 till November 2012 in total 247 pts with high surgical-risk underwent TAVI at our hospital using the CoreValve-Revalving system (26/29/31mm) in local anesthesia. The CoreValve prothesis was inserted retrograde by 18 F sheath. Of these pts, 24 pts presented with LGAS (aortic valve area (ava) < 1 cm2, mean pressure gradient (meanPG) < 40 mmHg and left ventricular ejection fraction (LVEF) < 40%), 70 pts with PLFAS (ava < 1 cm2, meanPG < 40 mmHg, LVEF ≥ 50%) and 153 pts with HGAS . The pts were followed up clinically and by echocardiography.
Results: At our hospital 24 pts with LGAS (age 78.7±1.1 years, log Euroscore 32.5±2.5, mean aortic gradient 28.5±1.1 mmHg, ava 0.7± 0.03 cm2 , LVEF 30.6±1.4 %) , 70 pts with PLFAS (age 81.2±0.8 years, log Euroscore 23.6±1.2, meanPG 31.8±0.8 mmHg, ava 0.7±0.02 cm2 , LVEF 54.3±1.0 %) and 153 pts with HGAS (age 81.5±0.5 years, log Euroscore 23.3±1.0, meanPG 52.5±0.9 mmHg, ava 0.6±0.01 cm2, LVEF 52.9±0.8 %) underwent successfully TAVI. The periprocedural mortality was 0% in all groups. Overall thirty-day mortality in our total cohort was 4.9% and longterm mortality (12 months) 14.6%. Thirty-day mortality was 8.3 % in the LGAS group, 7.1% in the PLFAS group and 3.2 % in the HGAS group.
Pts with LGAS had a significantly higher all-cause long-term mortality after TAVI compared to patients with PLFAS or HGAS. Long-term mortality in patients with LGAS was 37.5% compared to 14.3% in the PLFAS or 11 % in the HGAS group
Conclusion: TAVI shows excellent acute and intermediate results in patients with LGAS although the long-term mortality is significantly higher in patients with LGAS compared to patients with PLFAS or HGAS, but better than after conventional surgical aortic valve replacement reporting 30 days mortalities up to 30%.
- © 2013 by American Heart Association, Inc.