title: Clinical presentation and outcomes after transcatheter aortic valve implantation in patients with low flow/low gradient severe aortic stenosis.
abstract: OBJECTIVE
  To identify predictors of mortality, functional status, and hemodynamical changes of patients undergoing transcatheter aortic valve implantation (TAVI) for low flow/low gradient aortic stenosis (LF/LG AS).
  
  
  BACKGROUND
  There is little published data regarding the outcomes of patients with LF/LG AS following TAVI.
  
  
  METHODS
  Sixty-eight patients with severe AS, left ventricular dysfunction (ejection fraction [EF] <35%) and low flow (LF) AS underwent TAVI. Patients were stratified according to the aortic mean pressure gradient (low gradient [LG]; with Pmean ≤40 mm Hg and high gradient [HG]: Pmean >40 mm Hg). The baseline parameters and clinical outcomes were subsequently compared among the two groups. Cox proportional hazards were used to identify predictors of 6-month mortality.
  
  
  RESULTS
  There were 38 patients in the LG group and 30 patients in the HG group. There were no significant difference in 30-day mortality between the two groups. The 6-month and 1-year mortality, however, was 3.8-fold and 2.8-fold higher in the LG group than in the HG group (37.8% vs. 10.3%, P = 0.01 and 37.8% vs. 13.3%, respectively, P = 0.01). Univariable predictors for 6-month mortality were: STS Score, aortic valve area, and aortic mean pressure gradient. However, only STS Score (HR 1.08, 1.04-1.12, P < 0.001) remained as independent predictor in the multivariable analysis. Six months after TAVI, hemodynamical (EF > 50%) and clinical (NYHA class I) improvements were shown in both HG and LG groups.
  
  
  CONCLUSIONS
  LF/LG AS does not influence procedural mortality after TAVI but exhibits a strong impact on 6-month and 1-year mortality. The survivors, however, exhibit considerable hemodynamical and clinical improvements. Therefore, risk stratification and TAVI benefit should be weighted in every patient with LF/LG AS.
authors.affiliation: Clinic for Cardiovascular Surgery, German Heart Centre, Munich, Germany.
authors.forename: Yacine
authors.initials: Y
authors.lastname: Elhmidi
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Markus
authors.initials: M
authors.lastname: Krane
authors.forename: Marcus-André
authors.initials: MA
authors.lastname: Deutsch
authors.forename: Domenico
authors.initials: D
authors.lastname: Mazzitelli
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; 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; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Aorta; congestive heart failure; coronary artery disease; valvular heart disease