Abstract 16590: Outcome of TAVI in Patients With Low-Gradient and “Paradoxical” Low-Gradient Aortic Stenosis: Results of the German Aortic Valve RegistrY (GARY)
Objective: Patients (pt) with severe aortic stenosis (AS; AVA/BSA≤0.6cm2/m2) may present a mean transvalvular aortic gradient (MPG) <40mmHg due to either severe LV-dysfunction (low-flow, low-gradient; LG-AS) or concentric LV-remodelling with reduced stroke volume (“paradoxical” low-gradient, PLG-AS). However, the impact of these findings on mortality after TAVI is still undetermined. Herein, we analysed the outcome of patients undergoing TAVI for LG-AS (MPG<40mmHg and LVEF<40%), PLG-AS (EF≥50% and MPG<40mmHg) and high-gradient AS (HG-AS: MPG≥40) based on data from the GARY.
Methods and Results: 3908pt undergoing TAVI were included in this ongoing non-randomized national multicenter registry. LG-AS, PLG-AS and HG-AS were present in n=359 (9.2%; MPG: 26.5±7.3mmHg; EF: 30.3±7.3%), n=640 (16.4%; MPG: 30.7±6.5mmHg; EF: 60.2±7.8%) and n=1864 (47.7%; MPG: 55.5±13.8mmHg; EF: 56.3±12.5%) pt, respectively. EuroScore I (36.7±20.9 vs. 22.6±15.7 vs. 24.3±17.4; p<0.001) and patient age (79.1±6.1 vs. 80.5±5.6 vs. 81.4±6.1; p<0.001) were significantly different between groups. TAVI was performed transfemorally in the majority (68.5 vs. 68.5 vs. 71.0%, p=n.s.) with a high procedural success rate (>97.1% in all groups).
In-hospital mortality of pt with LG-AS was signficantly higher than with HG-AS (7.8 vs. 4.9%; p=0.029). In contrast, patients with PLG-AS had a comparable in-hospital mortality (P-LGAS 5.3 % vs. H-GAS 4.9%; p=0.67). The rate of TAVI-associated complications was without significant differences (new pacemaker: 23.9 vs. 20.0 vs. 22.4%; p=n.s.; cerebrovascular events: 3.3 vs. 3.8 vs. 3.4% p=n.s.). However, postoperative low cardiac output occurred more frequently in patients with L-GAS (8.7 vs. 4.0 vs. 4.2%; p<0.05). Further, patients with L-GAS and P-LGAS required a longer duration of mechanical ventilation compared to H-GAS (30.0± 83.6 vs. 37,7±125,0 vs. 24.8±94.1 hours; p=0.015)
Conclusion: Severe aortic stenosis with a mean transvalular gradient <40mmHg is a common finding and present in ≈25% of patients undergoing TAVI. In patients with low-flow, low-gradient AS in-hospital mortality after TAVI is significantly higher, however not in patients with “paradoxical” low gradient AS.
- © 2013 by American Heart Association, Inc.