Abstract 13120: Short-Term Outcomes of Transcatheter Aortic Valve Replacement in Very Low Gradient Severe Aortic Stenosis

Abstract

Introduction: Hemodynamic improvements following transcatheter aortic valve replacement (TAVR) have been show to correlate with outcomes. TAVR in patients with severe aortic stenosis (AS) and low mean gradients (MG) (<40mmHg) have demonstrated significant improvements in their MG post-TAVR. However, data on low, intermediate and high-risk patients with severe AS and very low MGs (<20mmHg) are lacking. Hypothesis: We hypothesized that patients with very low gradient severe AS see smaller improvements in MG but similar outcomes following TAVR using contemporary transcatheter heart valves (THV). Methods: This was a retrospective, observational study of 1114 low-, intermediate- or high-risk patients who underwent TAVR at our institution between 2015-2020. We trichotomized our population based on their pre-TAVR MG (cohort 1 (n=71): <20mmHg, cohort 2 (n=506): 20-39mmHg, cohort 3 (n=537): >40mmHg). We examined pre-TAVR and post-TAVR echocardiographic data. We examined in-hospital, 30-day and 1-year outcomes. Statistical analysis of outcomes was performed using two-sided t-test and one-way ANOVA. Results: Among the 1114 who underwent TAVR, 776 utilized the SAPIEN 3 or SAPIEN 3 Ultra THV and 338 utilized the CoreValve Evolut PRO THV. The patients had a mean age of 80.9 years with a mean Society of Thoracic Surgeons score of 6.4%. Patients in cohort 1 (15.4mmHg to 8.4mmHg, p<0.0001), cohort 2 (30.3mmHg to 9.6mmHg, p<0.0001) and cohort 3 (53.4mmHg to 11.6mmHg, p<0.0001) all saw significant improvement in their MG post-TAVR. Patients saw similar rates of death and stroke out to 1 year (Table 1). Conclusions: Our study of 1114 low-, intermediate- and high-risk patients who underwent contemporary TAVR demonstrated significant improvements in post-TAVR MGs across all variants of severe AS which translated to excellent short-term outcomes.