Results of Aortic Valve Replacement for Aortic Stenosis With Relatively Low Transvalvular Pressure Gradients

Low-Gradient Aortic Stenosis

“…[1][2][3][4][5]17 These patients are characterized by high operative risk and a dismal spontaneous prognosis. [1][2][3][4][5]17 In this situation, the cause of LV dysfunction may be true, severe AS with afterload mismatch 18 or primary cardiomyopathy with nonsevere AS.…”

“…[1][2][3][4][5]17 These patients are characterized by high operative risk and a dismal spontaneous prognosis. [1][2][3][4][5]17 In this situation, the cause of LV dysfunction may be true, severe AS with afterload mismatch 18 or primary cardiomyopathy with nonsevere AS. 3,4,7,8 We report the first multicenter study involving a large cohort of these patients; the main results are (1) confirmation that operative risk is well stratified by dobutamine stress hemodynamics; (2) justification for risk stratification in patients with a baseline MPG between 30 and 40 mm Hg; (3) a cut point for high operative risk in terms of MPG at 20 mm Hg; and (4) the rare occurrence of relative AS.…”

“…In previous studies, low-gradient AS was defined by a MPG Յ30 mm Hg 2,7,17,18 or Յ40 mm Hg. 1,3,4 In recent studies, operative risk for valve replacement varied from 8% to 21% 2,5 when MPG was Յ30 mm Hg and from 11% to 18% when MPG was Յ40 mm Hg. 1,3,4 Thus, it was important to determine the cut point for ranges of operative risk in terms of MPG; this cut point was a MPG Յ20 mm Hg in the present study.…”

“…P atients with severe aortic stenosis (AS), left ventricular (LV) dysfunction, and low transaortic pressure gradients (low-gradient AS) represent a common medical challenge considering their high operative mortality [1][2][3][4][5][6] and dismal spontaneous prognosis. 3,5 Dobutamine stress hemodynamics can differentiate between patients with true severe (fixed) AS, who are likely to benefit from valve replacement, and those with primary cardiomyopathy and nonsevere (relative) AS, for whom medical therapy may be indicated.…”

New concepts in valvular hemodynamics: Implications for diagnosis and treatment of aortic stenosis

“…This entity is generally characterized by the combination of an aortic valve EOA compatible with severe disease (ie, 1.0 cm 2 or less, or 0.6 cm 2 /m 2 or less when indexed for body surface area), a low transvalvular gradient (eg, mean gradient less than 40 mmHg), and a low ejection fraction (40% or less). Indeed, operative mortality for AVR in these patients is high, ranging between 8% and 33% depending on the study (37)(38)(39)(40)(41)(42)(43)(44)(45)(46). Moreover, this mode of presentation also represents a diagnostic challenge because at the outset, it is impossible to distinguish between patients having truly severe AS (TS AS) from those having pseudosevere AS (PS AS).…”