0049: TAVI for paradoxical or not low-flow low- gradient aortic stenosis patients: is it always a safe and useful procedure?

Abstract

The aim of the study was to assess the prognosis of three different aortic stenosis populations operated by TAVI: Severe aortic stenosis (SAS), lowflow low-gradient aortic stenosis (LFLG) and paradoxical low-flow low-gradient aortic stenosis (PLFLG). Between January 2010 and August 2013, patients with severe symptomatic aortic stenosis were consecutively referred to our institution, for TAVI because of multiple comorbidities and excessive surgical risk. We defined and split patients into 3 populations as followed: PLFLG (iAVA≤0.6 cm 2 , MG≤40 mmHg, SVI≤35mL/m 2 , LVEF≥50%, Zva>4.5 mmHg/mL/m 2 , MaxV<4m/s), LFLG (iAVA≤0.6 cm 2 , MG≤40 mmHg, MaxV<4m/s, LVEF≤50%, SVI≤3 5mL/m 2 ), and SAS (MaxV>4 m/s, MG>40 mmHg, LVEF>50%). The primary endpoint of our study was to evaluate global and cardiovascular mortalities; secondary endpoints included VARC 2 variables. A significant decrease in survival rate regarding the all-cause mortality (p=0.02) and cardiovascular mortality (p=0.05) was observed in the LFLG group (n=59) in comparison to the PLFLG (n=31) and SAS (n=172) groups, which had similar survival rates. Regarding the immediate post-procedural outcomes, the LFLG group had more CHF (p<0.001) and a higher BNP before discharge (p=0.009) than the other groups. VARC 2 variables analysis did not show any significant results. Intrahospital and 30-days mortalities were higher in the PLFLG and LFLG groups (p=0.05). There was a trend toward an increase in MACCE in the LFLG group (p=0.13) at one month. TAVI for PLFLG patients is feasible, safe, and has favourable outcomes. TAVI is a reasonable alternative in this group of patients, unlike LFLG patients who present higher mortality rate. Abstract 0049 – Figure: All-cause mortality Survival Rate