title: Transcatheter aortic valve implantation in patients with low-flow, low-gradient aortic stenosis.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy and outcome of transcatheter aortic valve implantation (TAVI) in patients with low-flow, low-gradient aortic stenosis (LG-AS).
  
  
  BACKGROUND
  Patients with LG-AS have a poor prognosis with medical treatment and a high risk for surgical aortic valve replacement.
  
  
  METHODS
  Between January 2009 and June 2010, a total of 1,302 patients underwent TAVI for severe AS and were prospectively included in the multicenter German TAVI registry.
  
  
  RESULTS
  LG-AS was present in 149 patients (11.4%; mean age: 80.2 ± 6.3 years). In this subgroup, the EuroSCORE was significantly higher (26.8 ± 16.6 vs. 20.0 ± 13.3; p < 0.0001) compared with patients with high-gradient AS (HG-AS). The procedural success rate (LG-AS: 95.3% vs. HG-AS: 97.5%; p = 0.13) and the rate of TAVI-associated complications were comparable in both groups (new pacemaker: 27.0% vs. 28.1%; p = 0.76; cerebrovascular events: 3.4% vs. 3.1%, p = 0.83). However, post-operative low-output syndrome occurred more frequently in the LG-AS-group (LG-AS: 14.9% vs. HG-AS: 5.7%, p < 0.0001), and mortality at 30 days and 1 year was significantly higher in this subgroup (LG-AS: 12.8% and 36.9% vs. HG-AS: 7.4% and 18.1%; p < 0.001 and p < 0.0001, respectively). Post-operative New York Heart Association functional class improved, and self-assessed quality of life increased significantly, demonstrating a substantial benefit in the LG-AS group at 30 days and 1 year after TAVI.
  
  
  CONCLUSIONS
  In high-risk patients with LG-AS, TAVI is associated with a significantly higher mortality at 30 days and at 1 year. However, long-term survivors benefit from TAVI with functional improvement and a significantly increased quality of life. Therefore, in view of the poor prognosis with medical treatment, TAVI should be considered an option in high-risk patients with LG-AS.
authors.affiliation: Department of Internal Medicine I, University Heart Center Jena, Jena, Germany. Electronic address: alexander.lauten@med.uni-jena.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lauten
authors.affiliation: Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.affiliation: Institut fuer Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Horack
authors.affiliation: CardioVascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.affiliation: Department of Cardiology, Herzzentrum Leipzig, Leipzig, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.affiliation: Department of Internal Medicine I, University Heart Center Jena, Jena, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Department of Cardiology, Sana-Herzzentrum Cottbus, Cottbus, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Harnath
authors.affiliation: Medizinische Klinik II, Universitaetsklinikum Bonn, Bonn, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.affiliation: Department of Cardiology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gerckens
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hanseatic Heart Center Hamburg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiology, Klinikum Muenchen Schwabing, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.affiliation: Institut fuer Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.affiliation: Department of Internal Medicine I, University Heart Center Jena, Jena, Germany.
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome