title: TAVI for low-flow, low-gradient severe aortic stenosis with preserved or reduced ejection fraction: a subgroup analysis from the German Aortic Valve Registry (GARY).
abstract: OBJECTIVE
  The study analyses the outcome of patients undergoing transcatheter aortic valve implantation (TAVI) for different subtypes of severe aortic stenosis (AS) based on data from the GARY registry.
  
  
  RESULTS
  Low-EF, low-gradient (LEF-LGAS: EF ≤40%, MPG <40 mmHg), paradoxical low-gradient (PLF-LGAS: EF ≥50%, MPG <40 mmHg) and high-gradient AS (HGAS: MPG ≥40 mmHg) were observed in 11.7% (n=359), 20.8% (n=640) and 60.6% (n=1,864) of the study population, respectively. EuroSCORE I (36.7±20.9 vs. 22.6±15.7 vs. 24.3±17.4; p<0.001) differed significantly among subgroups. In-hospital and one-year mortality were higher in patients with LEF-LGAS compared to HGAS (in-hospital: 7.8% vs. 4.9%; p=0.029; one-year: 32.3% vs. 19.8%; p=0.001). In contrast, mortality in patients with PLF-LGAS was comparable to patients with HGAS (in-hospital: PLF-LGAS: 5.3%; p=0.67; one-year: 22.3%; p=0.192). The rate of TAVI-associated complications was not significantly different among groups. However, postoperative low cardiac output occurred significantly more frequently in patients with LEF-LGAS Conclusions: Severe AS with a reduced transaortic flow and gradient is a common finding and is present in >30% of patients undergoing TAVI. Patients with low flow and impaired LV function have a significantly higher mortality within the first year after TAVI. In contrast, the outcome of patients with low flow and preserved EF is comparable to those with a high transvalvular aortic gradient.
authors.affiliation: Department of Internal Medicine I, University Heart Center Jena, Jena, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lauten
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: David
authors.initials: D
authors.lastname: Holzhey
authors.forename: Joachim
authors.initials: J
authors.lastname: Kötting
authors.forename: Andreas
authors.initials: A
authors.lastname: Beckmann
authors.forename: Christof
authors.initials: C
authors.lastname: Veit
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D012042:Registries; D013318:Stroke Volume; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality