The Impact of Flow-Improvement After Transcatheter Aortic Valve Replacement on Mortality in Patients with Low Flow and Severe Aortic Stenosis
Journal of the American College of Cardiology
Previous studies have suggested that low flow (LF) defined by a stroke volume index < 35 ml/m2 (SVI) pertains a poor prognosis in patients with severe aortic stenosis (AS). Limited data exists to compare those who normalize their flow versus those that remain with LF after TAVR. We compared the characteristics and 2-year mortality of patients with LF and AS who improved flow after TAVR to those with LF and AS who failed to improve flow.
Patients with severe AS and LF who underwent TAVR with an available SVI on discharge (DC) were included. Patients were stratified into normalized flow (NF) and LF according to their discharge (DC) SVI. Baseline characteristics, hemodynamics, and 2-year mortality were compared between both groups. Continuous data is reported as mean (±SD), categorical data as N (%), Kaplan-Meier estimates and log-rank test were used to assess the survival at 2-years. P<0.05 considered significant.
201 consecutive patients were included: 142 patients had LF while 59 had NF on DC. Both groups had the same baseline and TAVR valve characteristics. NF group had higher ejection fraction, SVI, and gradient, at baseline and higher aortic valve area, gradient, and SVI on discharge with better 2-year survival.
In patients with LF and severe AS, flow normalization after TAVR was associated with better survival at 2-years compared to those with LF on DC.
Kadri Amer N, George H, Ramy M, ahmed a, Francis S, Alessandro V, Steven A, Amr A. The impact of flow-improvement after transcatheter aortic valve replacement on mortality in patients with low flow and severe aortic stenosis. J Am Coll Cardiol [Internet]. 2021;77(18):905. Available from: https://doi.org/10.1016/S0735-1097(21)02264-6