Prognostic Impact of Low-Flow Severe Aortic Stenosis in Small-Body Patients Undergoing TAVR

Abstract

Among Japanese small-body patients with severe AS, both paradoxical LF and LF-LG severe AS were associated with poor outcomes following TAVR. SVi was an independent predictor of cardiovascular mortality after TAVR. (Optimised Transcatheter Valvular Intervention registry [OCEAN-TAVI]; UMIN000020423).

Prognostic impact of postprocedure stroke volume in patients with low-gradient aortic stenosis

“…Prior reports showed that pre-TAVI SVi is a powerful independent predictor of all-cause or cardiovascular mortality, and SVi is a better predictor of a left ventricular ejection fraction prognosis in patients with severe AS 3 15–17. The present study showed that post-TAVI SVi, not pre-TAVI, is an independent predictor of cardiovascular mortality and rehospitalisation for heart failure.…”

“…Low-gradient severe aortic stenosis (AS), which is classified into classical low-flow, paradoxical low-flow and normal-flow low-gradient AS, is associated with a higher mortality rate even after transcatheter aortic valve implantation (TAVI) than high-gradient severe AS 1 2. Our data also showed that a low-flow status was an independent predictor of cardiovascular mortality after TAVI 3. However, it has not yet been examined whether post-TAVI flow status affects the prognosis, especially in patients with low-gradient severe AS.…”

“…From October 2013 to July 2016, a total of 1613 consecutive patients with severe symptomatic AS who underwent TAVI with the Edwards Sapien XT, Edwards Sapien 3 (Edwards Lifesciences, Irvine, California) or Medtronic CoreValve prosthesis (Medtronic, Minneapolis, California) were enrolled prospectively in the Optimized Catheter Valvular Intervention-TAVI registry. The Optimized Catheter Valvular Intervention-TAVI registry is an ongoing Japanese prospective registry that aims to evaluate and observe the background and outcome in patients who undergo TAVI 3–5. Fourteen institutions contributed to this registry.…”

“…Analyses with Cox proportional hazards regression models were performed to estimate predictors of cardiovascular mortality and hospitalisation for heart failure. Age, sex and clinically relevant echocardiographic variables, with reference to prior studies, were included in the multivariate models using a stepwise variable selection method in which variables were either entered or removed if p<0.05 or p>0.1, respectively 1 3 9 10. The post-TAVI SVi threshold, which optimally predicted primary endpoints, was determined using the Youden Index of the receiver operating characteristic curves.…”

Changes in the nutritional and activity status of elderly patients within 6 months of transcatheter aortic valve replacement: A mixed methods approach

“…Since malnutrition is associated with poor outcomes (Barr & Schumacher, 2003), and malnutrition might consequently relate to decreased QOL or mortality because of frailty syndrome, we also collected the following data on known predictors of poor outcomes in QOL and mortality post-TAVR (Arnold et al, 2014;Carreras et al, 2018;Hermiller, 2016;Kataoka, 2018;Puls et al, 2014;Reynolds, 2011;Schoenenberger et al, 2013;Shimura, 2017;Tribouilloy et al, 2015): disease information (classification of the New York Heart Association; left ventricular ejection fraction, %; mean pressure gradient [mean PG]: ≤40.0 mm Hg, severe; aortic valve area [AVA]: ≤1.0 cm 2 , severe; peak flow velocity [V max ]: ≤4.0 m/s, severe), diagnosed LF-LG AS (Hachicha, Dumesnil, Bogaty, & Pibarot, 2007), mortality risk score using the Society of Thoracic Surgeons score (high risk: ≤10%), physical function status (5-m gait speed, sec/5 m), basic activities of daily living (ADL) and the Katz Index of Independence in ADL (Shelkey & Wallace, 2000), frailty status (Clinical Frailty Scale [CFS]; frailty: ≥5) (Rockwood et al, 2005), and cognitive functional status (Mini-Mental State Examination [MMSE]; normal, ≥24) (Mitchell, 2009). These assessment tools have widely confirmed reliability and validity.…”