title: Impact of low preprocedural transvalvular gradient on cardiovascular mortality following TAVI: an analysis from the FRANCE 2 registry.
abstract: OBJECTIVE
  To assess the relationship between a low preprocedural (<40 mmHg) mean transaortic gradient (MTG) and cardiovascular mortality following transcatheter aortic valve implantation (TAVI).
  
  
  RESULTS
  We studied highly symptomatic patients at high surgical risk who underwent TAVI, included in the FRANCE 2 multicentre registry. The primary endpoint was the incidence of any cardiovascular death in the year following the procedure. N=3,933 patients (age=82.8±7.2 years; EuroSCORE=21.8±14.1; left ventricular ejection fraction [LVEF]=55.5±12.6%) were enrolled. Low MTG was present in 23.5% of the cases. The one-year cardiovascular mortality was 13.3%. Cardiovascular survival was significantly lower in low MTG patients compared to the others. Multivariable Cox regression analysis revealed that a low MTG independently predicted cardiovascular death (HR=1.53 [1.15-2.04], p=0.004). Other independent predictors of cardiovascular mortality included preprocedural angina (HR=3.12 [1.64-5.96], p=0.0006); NYHA functional Class III-IV (HR=1.57 [1.07-2.29], p=0.02); severe renal failure (HR=1.50 [1.01-2.24], p=0.04); EuroSCORE (HR=1.01 [1.00-1.02], p=0.01); transapical access (HR=1.59 [1.14-2.22], p=0.006); impaired LVEF (HR=1.66 [1.23-2.27], p=0.0007) and post-procedural moderate to severe periprosthetic regurgitation (HR=2.13 [1.56-2.92], p<0.0001).
  
  
  CONCLUSIONS
  Presence of a low MTG prior to TAVI was associated with a greater risk of cardiovascular death up to one year following the procedure and could be used to identify patients at high risk for adverse cardiovascular outcomes following TAVI.
authors.affiliation: Institut Mutualiste Montsouris, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
authors.forename: Helene
authors.initials: H
authors.lastname: Agostini
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
authors.forename: Bernard
authors.initials: B
authors.lastname: Iung
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.forename: Jean
authors.initials: J
authors.lastname: Fajadet
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.forename: Michel
authors.initials: M
authors.lastname: Lievre
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D013318:Stroke Volume; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*; D016277:Ventricular Function, Left