Author + information
- Edward T. Carrerasa,b,
- Tsuyoshi Kanekoa,b,
- Fernando Ramirez-Del Vala,b,
- Marc P. Pelletiera,b,
- Piotr Sobieszczyka,b,
- Deepak Bhatta,b and
- Pinak Shaha,b
Background: Prior studies showed patients with low gradient (LG) and/or low flow (LF) severe aortic stenosis (AS) have worse outcomes after transcatheter valve replacement (TAVR). We sought to examine the interaction of LF, LG, and reduced ejection fraction (EF) on outcomes.
Methods: Data from 360 TAVR patients at Brigham and Women's Hospital from 2011 through 2015 were analyzed. LF was defined as stroke volume index (SVI) ≤35 mL/m2, LG as mean aortic gradient < 40 mmHg, and reduced EF as < 50%.
Results: LF was present in 101 (28.1%) patients, 51 (14.2%) of whom had preserved EF. There were no significant differences in baseline or procedural characteristics between groups. LF was associated with higher rates of in-hospital mortality and length of stay (p<0.001). At 1 year, LF was associated with higher rates of mortality (20.8% vs. 7.0%; HR, 2.99; 95% CI, 1.66 – 5.38; p<0.001) and heart failure (HF) readmission (21.8% vs. 5.0%; HR, 4.34; 95% CI 2.27–8.28; p<0.001). LG and reduced EF were not associated with in-hospital or 1-year mortality. Among patients with LF, those with preserved LVEF had significantly greater rates of mortality or HF at 1-year, while those with reduced LVEF had similar outcomes to patients without LF (Figure 1).
Conclusions: In patients undergoing TAVR, LF was a predictor of 1-year mortality and HF. Patients with LF and preserved EF had significantly greater mortality and HF at 1-year, while those with LF and reduced EF had similar outcomes to patients without LF.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: TAVR 1
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1114-159
- 2017 American College of Cardiology Foundation