TCT-710 Difference of Short Term Outcome in Low, Intermediate and High risk Patient in TAVI

Abstract

Withdrawn TCT-712 Clinical Outcomes of Patients With Low Flow, Low Gradient Severe Aortic Stenosis According To Treatment Modality Crochan J. O'Sullivan, Lars Englberger 1 , Stefan Stortecky 1 , Christoph Huber 1 , Nicola Hosek 1 , Ahmed Khattab 1 , Lutz Buellesfeld 1 , Thomas Pilgrim 1 , Bernhard Meier 2 , Peter Wenaweser 2 , Stephan Windecker 1 Bern University Hospital, Bern, Switzerland, University Hospital Bern, Bern, Switzerland Background: The aim of this study was to assess the role of transcatheter aortic valve implantation (TAVI) compared with medical treatment (MT) and surgical aortic valve replacement (SAVR) in patients presenting with low-flow, low-gradient (LFLG) severe aortic stenosis (AS). Methods: Between 2006 and 2012, 142 patients with LFLG severe AS (indexed aortic valve area [AVAi] 0.6cm2.m-2, ejection fraction [EF] <50% and mean gradient [MG] <40mmHg) and a complete pre-TAVI right and left heart catheterization underwent treatment allocation to MT (n1⁄428) SAVR (n1⁄441) or TAVI (n1⁄473). Results: Baseline characteristics were similar among patients allocated to MT and TAVI, whereas patients allocated to SAVR were younger (MT 82.0 5.2 vs SAVR 75.7 5.6 vs TAVI 82.2 4.8 years, p<0.0001) and were at lower predicted surgical risk (Logistic EuroSCORE MT 39.1 14.1 vs SAVR 20.7 13.6 vs TAVI 35.7 15.2%). Pre-procedural invasive hemodynamic indices were similar among MT and TAVI patients, whereas patients allocated to SAVR had a higher MG (p1⁄40.03) and EF (p1⁄40.008) and lower pulmonary artery (PA) systolic (p<0.0001) pressures. OverallMG was 26.4 8.4 mmHg, mean AVAi was 0.33 0.12, mean systemic vascular resistance was 2071.9 701.0 dyne.s.cm-2,mean PApressurewas 36.7 10.8mmHg andmean EF was 33.0 8.8 %. All-cause mortality at 30-days was similar among SAVR (4.9%) and TAVI (5.5%) patients, but was non-significantly higher among MT patients (17.9%, p1⁄40.08). Unadjusted rates of all-cause mortality at 12 months were significantly lower for SAVR (17.1%) and TAVI (17.8%) as comparedwithMT (42.9%, p1⁄40.02). Adjusted hazard ratios for death were 0.39 (95% confidence interval: 0.16 to 0.94) for SAVR compared withMT and 0.35 (95% confidence interval: 0.17 to 0.70) for TAVI compared with MT. Medical treatment (p1⁄40.02) and pulmonary hypertension (p1⁄40.03) were significantly associated with all-cause mortality at 12 months on multivariate analysis. Conclusions: Among patients with low-flow, low-gradient severe AS, SAVR and TAVI improved survival compared with MT. Clinical outcomes of TAVI and SAVR appeared similar among appropriately selected patients with LFLG severe AS.