Low-flow Low-gradient Aortic Stenosis Research Articles

Perioperative Outcome of Low Flow Low Gradient Aortic Stenosis in Transcatheter Aortic Valve Implantation. Insights from a Two Center Study with More Than 700 Patients

Objective: Our aim was to investigate the outcome of low flow low gradient aortic stenosis (LFLG-AS) after transcatheter aortic valve implantation (TAVI). Further, we analyzed the impact of the ejection fraction (EF) on the outcome of patients with LFLG-AS after TAVI.

Factors Associated with Low Flow in Aortic Valve Stenosis

Low-flow low-gradient aortic stenosis (AS) is a predictor of worse outcome compared with normal-flow AS. Although depressed left ventricular ejection fraction (LVEF) is associated with low flow, there is less evidence to support the role of other indices of cardiac structure and function. Clinical and echocardiographic data from patients with native AS and valve areas≤1.0cm(2) were retrospectively analyzed to identify characteristics that are associated with low-flow low-gradient AS. In total, 941 patients were included. On multivariate analysis, factors independently associated with low flow (stroke volume index<35mL/m(2)) included worse right ventricular systolic function, atrial fibrillation, lower LVEF, and higher left ventricular mass, with moderate or severe mitral regurgitation independently associated with low flow in the 694 patients (74%) with preserved LVEFs. Right ventricular dysfunction and atrial fibrillation are independently associated with low-flow low-gradient AS, while moderate or severe MR is independently associated with low flow in patients with preserved LVEF. These associations with low flow in AS are clinically important to recognize, to avoid underestimation of AS severity.

Cardiac resynchronization therapy in low-flow low-gradient aortic stenosis

A 74-year-old male with New York Heart Association (NYHA) Class IV heart failure, low-flow low-gradient (LFLG) aortic stenosis, and severe functional mitral regurgitation (MR) was referred for transcatheter aortic valve implantation. Medical history included permanent atrial fibrillation and complete heart block requiring dual-chamber pacemaker implantation. Coronary angiography showed no flow-limiting lesions. Transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction (LVEF) of 27%, stroke volume index (SVI) of 26 cc/m2, aortic valve area (AVA) of 0.77 cm …

Abstract 13459: Usefulness of B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin for Risk Stratification in Low Flow, Low Gradient Aortic Stenosis -A Substudy of the TOPAS Study

Background: B-type natriuretic peptide (BNP) and troponin T (TNT) have been shown to be associated with outcome in several clinical conditions. However the prognostic value of these 2 biomarkers combined together remains unclear. We aimed to explore the prognostic value of combined BNP and high-sensitivity TNT (hsTNT) in patients with low flow low gradient aortic stenosis (LGLG AS). Methods: Ninety eight patients (74±10 year; 75% men) with LFLG AS (LVEF &lt;50% and/or SVi&lt;35 ml/m2, mean gradient&lt;40 mmHg, AVAi&lt;0.6 cm2/m2) were prospectively enrolled in the TOPAS study and included in this analysis. The cohort was divided into three groups according to BNP and hsTNT plasma levels: Group A, patients with BNP&lt;550 pg/mL and undetectable TNT (hsTNT&lt;0.015 ng/mL); Group B, with BNP≥550 pg/mL or hsTNT≥0.015 ng/mL and Group C, patients with BNP≥550 pg/mL and hsTNT≥0.015 ng/mL. The primary endpoint was all-cause mortality. Results: Among the 98 patients, 32 (33%) were in Group A, 39 (40%) in Group B and 24 (27%) in Group C. During a median follow up of 2.8 [IQR=1.1-4.1] years, 55 patients died. Patients in Group C were older and had lower LVEF (all p&lt;0.05). Two-year mortality was higher in Group C (41±9%) than in Group B (23±7) and Group A (5±4%) (p=0.0019). In Group B, there was no significant difference in 2-year mortality rates between the subgroup with hsTNT≥0.015 ng/mL versus that with BNP≥550 pg/mL (26±9% vs. 11±10%, respectively, p=0.21). In multivariable analysis adjusted for age, type of treatment (AVR vs. conservative), coronary artery disease and LVEF, Group C remained independently associated with increased risk of mortality (HR= 4.25; p=0.023), and Group B tended to have higher mortality (HR=3.63; p=0.058) as compared to Group A. Conclusion: The results of this study demonstrate the usefulness of combined measures of BNP and hsTNT to enhance risk stratification in patients with LFLG AS. Patients having activation of both BNP and hsTNT have a 4-fold increase risk of mortality.

Abstract 19826: Utility of Stroke Volume Index for Stratification of Patients With Low Gradient Severe Aortic Stenosis and Normal Left Ventricular Ejection Fraction

Background: Decision of intervention for low gradient severe aortic stenosis (AS) with normal left ventricular ejection fraction (LVEF) is clinically challenging. The study was to determine the impact of stroke volume index (SVi) on prognosis in patients (pts) with AS. Methods: We examined 410 pts with moderate or severe AS and normal EF (≥50%). Pts were divided into four groups based on aortic valve area (AVA), mean pressure gradient (MPG) and SVi: Group I: low flow low gradient severe AS (AVA≤1.0cm 2 , MPG&lt;40mmHg and SVi&lt;35mL/m 2 , n=75); Group II: normal flow low gradient severe AS (AVA≤1.0cm 2 , MPG&lt;40mmHg and SVi≥35mL/m 2 , n=97); Group III: severe AS with matched gradient-AVA (AVA≤1.0cm 2 and MPG≥40mmHg, n=88); Group IV: moderate AS (AVA&gt;1.0cm 2 and MPG&gt;20mmHg, &lt;40 mmHg, n=150). Aortic valve gradients, AVA and SVi were assessed by echocardiography. Clinical charts were reviewed. Mean follow-up duration was 3.2±1.6 years. Results: Group I had higher prevalence of atrial fibrillation, more pronounced LV hypertrophy, lower SVi, smaller AVA, higher valvuloarterial impedance (Zva) (Table) and lower 3-year cumulative survival compared to Group II and Group IV (61% vs. 75% and 80%, p=0.004). Group II had a 3-year cumulative survival similar to moderate AS (75% vs. 80%, p&gt;0.05). In pts with medical management, Group I and Group III had lower 3-year cumulative survival in comparison with Group II and Group IV (48% and 56% vs. 73% and 76%, p=0.001). Multivariate analysis showed SVi was a strong predictor of mortality in low gradient severe AS (HR 0.95, CI: 0.91-0.99, P=0.02). However, in gradient-AVA matched severe AS and moderate AS, SVi was not associated with mortality (p&gt;0.05). Conclusions: Without AS intervention, low flow low gradient severe AS with normal EF carries poor prognosis similar to high gradient AS, but normal flow low gradient AS does not, suggesting that SVi may be used to identify the pts benefiting most from AS intervention in pts with low gradient AS.

Abstract 11676: Importance of Longitudinal Dyssynchrony in Low Flow Low Gradient Severe Aortic Stenosis Patients Undergoing Dobutamine Stress Echocardiography. A Multicenter Study (on behalf of the HAVEC group)

Introduction: Patients with reduced left ventricular ejection fraction (LVEF), low-flow low-gradient aortic stenosis (LFLG AS) represent a challenging cohort with high morbidity and mortality. Low-dose dobutamine stress echocardiogram (DSE) is recommended for assessment of flow reserve (FR, defined as ≥ 20% increase in stroke volume) which is prognostically important. Hypothesis: Presence of longitudinal dyssynchrony (LD) is independently associated with no FR during DSE. Methods: 185 LFLG AS patients from 4 different institutions who underwent DSE between 1997 through 2013 were studied. Baseline LD, transverse dyssynchrony and strain analysis were performed using vendor-independent 2D CPA TomTec software using DICOM images from apical 2 and 4-chamber and feasible in 97% of patients (N=179). Multivariate logistic regression analysis of predictors of no FR was performed. Results: The mean age was 74 ± 9 yrs; LVEF 30 ± 10%; indexed AV area 0.44 ± 0.1 cm2/m2; mean AV gradient 24 ± 7 mmHg; mean QRS width 126 ± 32 msec and 28% of the cohort had a QRS width ≥ 130 msec. LD, pre-defined as maximum opposite wall delay ≥ 130 msec, was present in 83% (149/179) of study cohort, whereas FR on DSE was present in 54%. Coronary artery disease was more common in those without FR. Although baseline LVEF was not different according to FR status (p=0.23), greater LV stroke volume index (p=0.001) and longitudinal strain (p=0.004) were seen in those without FR. LD was more prevalent in patients without FR (90% vs 77%, p=0.02). On multivariate analysis (Figure 1), presence of LD (HR=4.58, p=0.01) was an independent predictor of no FR despite several adjustments. Conclusions: LD is very prevalent in patients with LFLG AS undergoing DSE. Quantification of LD provides important insights as LD is independently associated with no FR. Whether LD improves after valvular intervention and whether its correction confers a better prognosis to these patients remains to be studied.

Dobutamine stress echo for suspected paradoxical low-flow low-gradient severe aortic stenosis: Value of left ventricular wall thickening assessment

Dobutamine stress echo for suspected paradoxical low-flow low-gradient severe aortic stenosis: Value of left ventricular wall thickening assessment

96 Resting Aortic Valve Area at Normal Transaortic Flow Rate but not at Normal Stroke Volume Reflects the True Valve Area in PTS with Low Gradient Severe Aortic Stenosis: Implications for Obviating the Need for Stress Echocardiography in such PTS

<h3>Objectives</h3> The purpose of this study was to compare the diagnostic impact of stress echocardiography (SE) in patients with suspected low-flow low-gradient aortic stenosis (LFLGAS) but normal resting transvalvular flow rate. <h3>Background</h3> SE may help to distinguish between true LFLGAS, and pseudo severe stenosis in patients with low aortic valve area (AVA) and mean gradient (MG). However, if rest flow rate is normal then SE may not confer any additional diagnostic value, irrespective of resting left ventricular ejection fraction (LVEF) and indexed stroke volume (SVi). <h3>Methods</h3> Thirty-nine patients with suspected LFLGAS who underwent SE in a single institution were retrospectively studied. Following stratification by rest LVEF, SVi and flow rate – using cut-offs of 40%, 35 ml/m² and 200 ml/sec respectively – we tested for significant changes in AVA during SE. <h3>Results</h3> Mean age was 77 ± 8 years and 72% were male. Mean values for rest variables were: AVA 0.79 ± 0.13 cm²; MG 26 ± 6 mmHg; flow rate 186 ± 37 ml/s; SVi 33 ± 8 ml/m² and LVEF 44 ± 15%. During stress, significant increases in AVA were observed regardless of resting LVEF and SVi status, and only in patients with low rest flow rate. In patients with rest flow rate &gt;200 ml/s, AVA did not increase significantly during stress (rest AVA 0.90 cm² vs stress 0.97 cm², p = 0.11). In adjusted analyses, rest flow rate was the only parameter associated with severe AS (OR=0.94, p = 0.01). <h3>Conclusions</h3> Rest AVA measured under normal flow rate conditions is likely to reflect the true severity of AS – and unlikely to change significantly with SE. Flow rate normalisation during stress may only be required in patients with AVA &lt; 1 cm² and transvalvular mean gradient &lt; 40 mmHg when the flow rate is &lt;200 ml/s.

Low-Flow Aortic Stenosis and Reduced Ejection Fraction: New Insights.

Low-Flow Aortic Stenosis and Reduced Ejection Fraction: New Insights.

Calcification Characteristics of Low-Flow Low-Gradient Severe Aortic Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement.

Low-flow low-gradient severe aortic stenosis (LFLGAS) is associated with worse outcomes. Aortic valve calcification patterns of LFLGAS as compared to non-LFLGAS have not yet been thoroughly assessed. 137 patients undergoing transcatheter aortic valve replacement (TAVR) with preprocedural multidetector computed tomography (MDCT) and postprocedural transthoracic echocardiography were enrolled. Calcification characteristics were assessed by MDCT both for the total aortic valve and separately for each leaflet. 34 patients had LFLGAS and 103 non-LFLGAS. Total aortic valve calcification volume (p < 0.001), mass (p < 0.001), and density (p = 0.004) were lower in LFLGAS as compared to non-LFLGAS patients. At 30-day follow-up, mean transaortic pressure gradients and more than mild paravalvular regurgitation did not differ between groups. In conclusion, LFLGAS and non-LFLGAS express different calcification patterns which, however, did not impact on device success after TAVR.

Abstract 13983: Tricuspid Regurgitation is Independently Associated With Increased Risk of Mortality in Patients with Low-Flow Low-Gradient Aortic Stenosis and Reduced Ejection Fraction-Results From the TOPAS Study

Background: Tricuspid regurgitation (TR) is often observed in patients (pts.) with low-flow, low-gradient aortic stenosis (LF-LG AS) and low ejection fraction (EF). Its impact on prognosis remains unknown. The objective of this study was to examine the impact of TR on mortality in these pts. Methods: 211 pts. (age=73±10 yrs; 77% men) with LF-LG AS (mean gradient&lt;40 mmHg, AVA ≤0.6 cm2/m2) and low EF (≤40%) were prospectively enrolled and 125 (59%) underwent aortic valve replacement (AVR) within 3 months following inclusion. AS severity was assessed by the projected AVA. The severity of TR was graded according to ASE guidelines. Right ventricular (RV) function was assessed using an integrative approach and classified as normal or reduced. Results: Among the 211 pts., 76 (36%) had TR (24% mild TR and 12% moderate/severe TR). During a mean follow up of 2.4±2.2 yrs, 104 (49%) died. In univariable analysis, TR was associated with an increased risk of all-cause mortality (overall TR: HR=1.82; 95% CI=1.22-2.71; p=0.004; mild TR: HR=1.62; 95% CI=1.02-2.54; p=0.04; moderate/severe TR: HR=2.30; 95% CI=1.27-3.93; p=0.007). After adjustment for risk factors and echocardiographic parameters including RV function, TR was an independent predictor of mortality (overall TR: HR=1.88; 95% CI=1.08-3.23; p=0.02; mild TR: HR=2.19; 95% CI=1.00-4.77; p=0.05; moderate/severe TR: HR=2.68; 95% CI=1.08-6.32; p=0.03). Furthermore, moderate/severe TR was an independent predictor of 30-day mortality following AVR compared to none/trace TR (OR=7.24; p=0.01) and mild TR (OR=4.70; p=0.05). Conclusion: In patients with LF-LG AS and low EF, TR is independently associated with an increased risk of mortality. Moderate/severe TR is associated with increased 30-day mortality following AVR. Further studies are needed to determine whether TR is a risk marker or risk factor of mortality, and whether concomitant surgical correction at the time of AVR can improve outcome in these high risk patients.

Unexpected progression to high gradient in paradoxical low flow-low gradient aortic stenosis

a Universite Lille Nord de France, GCS-Groupement des Hopitaux de l'Institut Catholique de Lille, Faculte Libre de Medecine, Cardiology Department, Universite Catholique de Lille, 59000 Lille, France b Cardiology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble, France c Pole Cardiovasculaire et Thoracique, Centre Hospitalier Universitaire Amiens, Amiens, France d INSERM U 1088, Universite de Picardie, Amiens, France

Assessment of low-flow, low-gradient aortic stenosis: multimodality imaging is the key to success.

In patients with aortic stenosis (AS), a low-flow state may occur with reduced LV ejection fraction (LVEF) (i.e., classic low flow) or with preserved LVEF (i.e., paradoxical low flow) and it is often associated with low gradient because the gradient is highly flow-dependent. Low-flow, low-gradient (LF-LG) AS is a frequent clinical entity generally associated with worse outcomes. A multimodality imaging approach, including comprehensive resting echocardiography, dobutamine stress echocardiography (DSE), and multidetector computed tomography (MDCT), is the key to successful management of patients with LF-LG AS, who represent a highly challenging subset from both a diagnostic and a therapeutic standpoint. DSE and quantification of aortic valve calcification by MDCT provide important information that is crucial to differentiate true-severe from pseudo-severe AS and therefore select the most appropriate therapy (i.e., AVR vs. medical). The assessment of LV flow reserve by DSE is useful to stratify the operative risk and guide decision making between surgical and transcatheter AVR. Other imaging biomarkers, such as the global LV longitudinal strain measured during DSE or the amount of myocardial fibrosis assessed by cardiac magnetic resonance imaging, may provide incremental information for risk stratification and therapeutic management in LF-LG AS, but additional studies are needed to validate and refine these emerging biomarkers further.

Outcomes in Patients With Various Forms of Aortic Stenosis Including Those With Low-Flow Low-Gradient Normal and Low Ejection Fraction

Low-flow low-gradient aortic stenosis with normal ejection fraction (LFLGNEF AS) is a newly characterized poorly understood entity within the AS spectrum. Whether LFLGNEF AS has a worse prognosis than typical AS remains controversial. We retrospectively identified 4,546 individual patients with any type of AS on echocardiogram from 2003 through 2013 and categorized them into 5 cohorts: (1) mild AS, (2) moderate AS, (3) severe AS, (4) LFLGNEF AS (ejection fraction≥55%), and (5) low-flow low-gradient low ejection fraction AS (LFLGLEF AS; ejection fraction<55%). Survival analysis was used to compare outcomes of LFLGNEF AS with those of the other cohorts. AS was classified as mild in 591 patients, moderate in 2,358, severe in 500, LFLGNEF in 776, and LFLGLEF in 318. The study group had a mean age of 80.5 years, 61% were women, and the patients were followed for 2.26±1.16 years. Among subjects managed without valve replacement, total mortality for the LFLGNEF AS group was lower compared with that in both the severe AS and the LFLGLEF AS groups (p=0.007 and p<0.001, respectively). The prognosis for LFLGNEF AS was worse, however, compared with those with mild and moderate AS (p<0.001, both). In conclusion, no survival differences were found among AS types among those who received valve replacement. The survival rate in LFLGNEF is better than that in severe AS or LFLGLEF but is worse than that in mild or moderate AS. Valve replacement seems reasonable to pursue in select patients.

Immediate Improvement of Left Atrial Appendage Contractility after Transcatheter Aortic Valve Replacement in a Patient with Paradoxical Low-Flow Low-Gradient Aortic Stenosis and Preserved Left Ventricular Function

Paradoxical low-fl ow, low-gradient severe aortic stenosis with preserved left ventricular (LV) ejection fraction is a recently recognized entity characterized by impaired LV fi lling, altered myocardial function, and worse prognosis. We have shown, for the fi rst time that transcatheter aortic valve replacement is associated with immediate improvement of left atrial mechanical function, as demonstrated by the disappearance of spontaneous echo contrast and increase in left atrial appendage contractility. Key words: Left atrial function, paradoxical low-fl ow, low-gradient severe aortic stenosis, transcatheter aortic valve replacement

Left Ventricular Functional Recovery and Remodeling in Low-Flow Low-Gradient Severe Aortic Stenosis after Transcatheter Aortic Valve Implantation

Speckle-tracking-derived global longitudinal strain (GLS) is a more sensitive method of detecting left ventricular (LV) functional recovery after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. However, it remains unknown whether LV function improves in patients with low-flow, low-gradient severe aortic stenosis (LFLGSAS) after TAVI. The aim of the present was to evaluate LV functional recovery and remodeling after TAVI in patients with LFLGSAS. Sixty-eight patients (57% men; mean age, 79.1 ± 7.1 years) with LFLGSAS treated with TAVI were evaluated. LV function and remodeling were investigated before TAVI and at 6 and 12 months after TAVI. All echocardiographic data were prospectively collected, and GLS was retrospectively analyzed. Among patients with LFLGSAS, 35 (52%) had low LV ejection fraction (LVEF) (<50%), and 33 (48%) had preserved LVEF (≥50%). The low-LVEF group had significantly more impaired GLS than the group with preserved LVEF (-8.3 ± 2.6% vs -13.3 ± 3.5%, P < .001). LV systolic function improved after TAVI in both groups. Although in the group of patients with low LVEF, all functional parameters improved, in the group of patients with preserved LVEF, only strain-derived parameters significantly improved. There were significant decreases in absolute LV wall thickness and relative wall thickness and a trend toward decreased LV mass index in both LVEF groups. LV volumes decreased significantly in those with low LVEF but not in those with preserved LVEF. Baseline GLS but not LVEF group was independently associated to GLS improvement at 12 months after TAVI. Patients with LFLGSAS with low and preserved LVEF had a significant improvement in LV function after TAVI, as assessed by GLS. Absolute and relative LV wall thickness decreased in both groups of patients, but only those with low LVEF had reductions in LV volumes.

How transcatheter aortic valve implantation can revive balloon aortic valvuloplasty

Until recently, percutaneous balloon aortic valvuloplasty (PBAV) had limited indications as a bridge to surgical aortic valve replacement in elderly patients with depressed left ventricular function. Since the advent of transcatheter aortic valve implantation (TAVI), most high-surgical risk patients are currently referred for TAVI, allowing for a new role for PBAV in three subsets of patients who cannot perform TAVI as first-line treatment: presence of hemodynamic instability – PBAV may improve the clinical status and allow to perform TAVI; presence of a low-flow low-gradient aortic stenosis – PBAV may reveal who benefits from a stable decrease in aortic gradient; and need for major noncardiac surgery – PBAV may reduce the operative risk and allow subsequent definition of the indication to TAVI.

Can restrictive filling pattern on dobutamine stress echocardiography predict recovery of left ventricular systolic function after valve replacement in patients with low flow-low gradient aortic stenosis?

Abstract Background Low flow/low gradient severe aortic stenosis continues to be a common medical problem with spontaneous dismal prognosis if left untreated. Relationship between improvement and persistence of restrictive filling pattern (that is present on baseline echocardiography) on DSE (dobutamine stress echocardiography) and recovery of LV systolic function after AVR has not been studied before. Objective We sought to clarify the relationship between improvement and persistence of restrictive filling pattern (that is present on baseline echocardiography) on DSE and recovery of LV systolic function after AVR. Patients and methods Thirty patients with LF/LG severe AS and restrictive filling pattern on baseline echocardiogram were divided into two groups. Group I included 17 patients with improved diastolic functional class during DSE, and group II included 13 patients with persistent restrictive pattern on DSE study. All patients had a contractile reserve and had AVR afterward. Results All patients had restrictive filling pattern. No significant difference was found between both groups regarding AVA, mean transaortic gradient, SV, LVEF, E/A ratio, IVRT, DT, S/D ratio, LV septal thickness or LVEDD ( p > 0.05). On DSE, group I patients had a significantly more rise in both EF and SV (49.2 ± 5.4% in group I compared to 42.5 ± 6.9% in group II and 66 ± 9 compared to 58 ± 9 ml respectively, p p p p p = 0.009) and non-restrictive pattern at peak stress (β coefficient 10.084, p Conclusion Persistence of LV restrictive filling pattern during DSE in patients with LF/LG severe AS could be associated with less LV systolic function recovery after AVR.

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

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

First case reported of transcatheter aortic valve implantation in a patient affected by Fabry’s Disease and severe low-flow low-gradient aortic valve stenosis

Normal 0 false false false EN-US ZH-CN X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:普通表格; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} Fabry’s disease is a rare X-linked lysosomal storage disorder in which cardiac involvement is common manifesting as arrhythmias, coronary artery disease, valvular disorders and restrictive cardiomyopathy. We describe a case of a 76-year-old female affected by Fabry’s disease and severe low-flow low-gradient aortic stenosis that underwent transcatheter aortic valve implantation (TAVI) in our center. No complications occurred during the procedure or in the peri-procedural period. The patient was discharged 5 days later, in a much improved clinical and haemodynamic state. At long-term follow-up there was a remarkable improvement in left ventricular systolic function despite the underlying cardiomyopathy. Despite absence of previous experience, our case report indicates that TAVI can be a feasible and effective therapeutic option for aortic stenosis in patients with Fabry’s disease.