title: Transcatheter aortic valve implantation for paradoxical low-flow low-gradient aortic stenosis patients.
abstract: OBJECTIVE
  We compared the outcomes of transcatheter aortic valve implantation (TAVI) in three different aortic stenosis syndromes: paradoxical low-flow low-gradient aortic stenosis (PLFLG), high-gradient aortic stenosis (HGAS), and low ejection fraction low-gradient severe aortic stenosis (LEF-LG).
  
  
  BACKGROUND
  Outcomes for PLFLG patients after TAVI procedure are not well known.
  
  
  METHODS
  Between 2010 and 2013, patients with severe (indexed aortic valve area iAVA≤0.6 cm(2)/m(2)) symptomatic aortic stenosis were consecutively referred to our institution for TAVI because of multiple comorbidities and excessive surgical risk. About 262 patients were split into three groups as following, PLFLG: mean gradient MG≤40 mm Hg, stroke volume index SVI≤35 mL/m(2), ejection fraction EF≥55%, valvuloarterial impedance Zva>4.5 mm Hg/mL/m(2), maximal aortic jet velocity MaxV<4 m/s;
  MG≤40 mm Hg, MaxV<4 m/s, EF≤50%, SVI≤35 mL/m(2); and HGAS: MaxV>4 m/s, MG>40 mm Hg, EF>55%. The primary endpoint of our study was to evaluate mid-term global and cardiovascular mortalities; secondary endpoints included recommended VARC-2 variables.
  
  
  RESULTS
  PLFLG (n = 31) mid-term survival was similar to HGAS (n = 172) (mean follow-up = 13.2 months [4.6-26]). Conversely LEF-LG patients (n = 59) displayed significant higher rates of all-cause (P = 0.01) and cardiovascular mortalities (P = 0.05). Postprocedural outcomes (VARC-2 criteria) were similar in the PLFLG and HGAS groups except regarding major bleeding (P = 0.02), while the LEF-LG group had more congestive heart failure and a higher BNP before discharge (both P < 0.001) than the other groups. 30-days deaths were significantly more frequent in LEF-LG and PLFLG in comparison to HGAS (P = 0.03).
  
  
  CONCLUSIONS
  As opposed to LEF-LG patients, mid-term prognosis after TAVI procedure in PLFLG patients is similar to HGAS patients despite higher perioperative mortality.
authors.affiliation: Heart Team, Lille University Hospital, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Debry
authors.affiliation: Heart Team, Lille University Hospital, Lille, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Sudre
authors.affiliation: Heart Team, Lille University Hospital, Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Amr
authors.affiliation: Heart Team, Lille University Hospital, Lille, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Delhaye
authors.affiliation: Heart Team, Lille University Hospital, Lille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Schurtz
authors.affiliation: Heart Team, Lille University Hospital, Lille, France.
authors.forename: David
authors.initials: D
authors.lastname: Montaigne
authors.affiliation: Heart Team, Lille University Hospital, Lille, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Koussa
authors.affiliation: Heart Team, Lille University Hospital, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
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 / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: aortic stenosis; low ejection fraction low-gradient aortic stenosis; paradoxical low-flow low-gradient aortic stenosis; transcatheter aortic valve implantation