Abstract 15315: Impact of Low Flow State on Cumulative Mortality of High-risk Patients Undergoing Transcatheter Aortic Valve Implantation
Introduction: Although low ejection fraction (LVEF) has been reported to be an independent risk factor for increased mortality following surgical aortic valve replacement, its impact on post-procedural transcatheter aortic valve intervention (TAVI) outcome has yielded conflicting results. Moreover, a low-flow state, evaluated by the reduced LV stroke volume index (SVi), can occur with both reduced and preserved LVEF.
Hypothesis: We aimed to assess the impact of pre-procedural flow (i.e., SVi), LV ejection fraction (LVEF) and transvalvular gradient on 2-year all cause mortality following TAVI in patients with severe aortic stenosis
Methods: Patients with severe and symptomatic aortic stenosis (AS) (effective orifice area [EOA]≤1cm2) who were scheduled for TAVI with Corevalve at our institution were prospectively enrolled. Patients with “valve-in-valve” procedure, TAVI for other indication than severe aortic valve stenosis and/or incomplete pre-procedural Doppler echocardiographic data were excluded from the study. Primary end-point was 2-year all cause mortality was defined according to the criteria proposed by the Valve Academic Research Consortium.
Results: We included 130 patients (mean age: 79.9±7.2 years). Ninety-five (73.1%) patients had normal flow (SVi>35ml/m2) and 35 (26.9%) low flow (SVi<35ml/m2). Overall, the primary end point occurred in 17 (13.1%) patients during a median follow-up period of 24 months. Patients with low flow had higher 2-year all cause mortality compared with those in the normal flow group (37.1% versus 4.2%, p<0.01). Mortality was also increased in patients with low LVEF compared with those with normal LVEF (17.2% versus 11.8%, p=0.01). Patients with low mean gradient had higher 2-year all cause mortality compared with those in the normal flow group (25.5% versus 9.1%, p<0.01). By multivariate analysis only SVi was independent predictor of mortality (p<0.01, OR: 0.08, 95% CI: 0.02-0.03).
Conclusions: Low flow but not low ejection fraction or low gradient is an independent predictor of 2-year cumulative mortality following TAVI in high risk patients with severe AS. SVi should be integrated in the risk stratification process of these patients.
Author Disclosures: M. Drakopoulou: None. K. Toutouzas: None. A. Mastrokostopoulos: None. K. Stathogianis: None. G. Trantalis: None. G. Latsios: None. A. Synetos: None. S. Brili: None. G. Benetos: None. D. Tousoulis: None. C. Stefanadis: None.
- © 2014 by American Heart Association, Inc.