Abstract 13728: Evolution and Prognostic Impact of Low Flow After Transcatheter Aortic Valve Replacement
Background: The presence of low LV outflow, i.e. reduced stroke volume index (SVi), prior to the procedure has been recently shown to be a powerful independent predictor of early and late mortality in high-risk patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). The objective of this study was to assess the evolution of SVi after the procedure and to examine the impact of persistent low-flow state on late mortality.
Methods: We retrospectively analyzed the clinical, Doppler-echocardiographic, and outcome data prospectively collected in 288 patients who underwent TAVR for symptomatic severe AS. Echocardiograms were performed before and within 7 days after procedure.
Results: Post-TAVR echocardiographic data were available in 255 (89%) patients. Mean follow-up was 18 ± 15 months. Patients with early post-procedural SVi (PP-SVi) <35 ml/m2 (n=138; 54%) had increased mortality (HR: 1.97, p =0.003) compared to those with PP-SVi >35 ml/m2 (n=117; 46%). Furthermore, patients with baseline (pre-procedural) SVi (B-SVi) <35ml/m2 and PP-SVI >35ml/m2, i.e. with normalized flow, had better survival (HR: 0.46, p=0.03) than those with both B-SVi and PP-SVi <35ml/m2, i.e persistent low-flow, and similar survival compared to those with both B-SVi and PP-SVi >35 ml/m2, i.e. maintained normal flow. In a multivariable model adjusted for gender, atrial fibrillation, trans-apical/transfemoral approach and post-procedural echo parameters (LVEF, mean gradient, pulmonary hypertension, moderate or severe aortic and mitral regurgitations), PP-SVi was independently associated with increased risk of mortality (HR 1.41 per 10 ml/m2 decrease, p=0.03). The pre-/intra-procedural factors associated with PP-SVi <35 ml/m2 were: atrial fibrillation (OR: 2.55, p=0.01), trans-apical approach (OR: 2.46, p=0.002), mean transvalvular gradient (OR: 1.22 per 10 mmHg decrease, p=0.05), and indexed aortic valve area (OR: 1.67 per 0.1 cm2/m2 decrease, p=0.02).
Conclusion: The persistence of low-flow early after the procedure is an independent predictor of late mortality following TAVR.
- © 2013 by American Heart Association, Inc.