Prognostic Impact of Different Subtypes of Severe Aortic Stenosis after Transcatheter Aortic Valve Implantation

Abstract

PurposeOutcomes for different subtypes of aortic stenosis (AS) after transcatheter aortic valve implantation (TAVI) are still subjects of debate. The aim of the study was to evaluate the prognostic impact of baseline flow rate (F) and mean gradient (G) on survival after TAVI. MethodsFrom 2008. to 06. 2017. TAVI was performed in 300 cases (127 men, 173 women, age 80,0±5,8 years) with severe AS. Follow-up was at least 3 years. Mortality tracking was 100%. Patients were divided into high gradient (HG: 237), low-flow low-gradient (LF-LG: 41), paradoxically low flow-low gradient (PLF-LG: 9) and normal flow-low gradient (NF-LG: 13) groups. Primary endpoint was 30-day, 1-year and 3-year all-cause mortality (M) . ResultsNF-LG had better prognosis (M: 30d 0, 1-year: 7,7%, 3-year: 46,2%). In HG patients mortality was low in the 1st year (30-day: 3,8%, 1-y: 14,3%), but higher (62,8%) after 3 year. PLF-LG had intermediate outcomes (30-day 0, 1-year 22,2%, 3-year 55,6%). LF-LG had the highest mortality (30-day 12,2%, p=0,03, 1-year 34,2% p=0,005, 3-year 75,6% p=0,009 vs.HG) and relative risk (2,44 [1,34-4,42] p=0,003 vs.HG). Independent predictors of 1-year mortality were only Grade 2+ paravalvular regurgitation (p=0,04) and severe renal dysfunction (p=0,04). ConclusionsTAVI survival is determined by the guideline-defined subtype of AS. Low flow – low gradient AS is associated with worse prognosis, therefore these patients need careful management after TAVI.