Author + information
- Mohamad Kabach1,
- Abdulah Alrifai1,
- Jesus Pino Moreno2,
- Pradeep Dayanand2,
- Edwin Grajeda2,
- Lawrence Lovitz2,
- Mark Rothenberg3,
- Roberto J. Cubeddu4,
- Cristiano Faber2,
- Marcos Nores5 and
- Zaher Fanari6
- 1University of Miami/JFK Medical Cener, West Palm Beach, Florida, United States
- 2University of Miami School of Medicine/JFK Medical Center, West Palm Beach, Florida, United States
- 3University of Miami School of Medicine/JFK Medical Center, Atlantis, Florida, United States
- 4Cleveland Clinic Florida, Weston, Florida, United States
- 5JFK Medical Center, Wellington, Florida, United States
- 6University of Kansas School of Medicine, Wichita, Kansas, United States
The long term impact of transcatheter aortic valve replacement (TAVR) in patients with paradoxical LG/LF aortic stenosis and preserved ejection fraction constitutes subjects of an evolving debate.
We identified consecutive patients presenting for TAVR between 01/2011 to 6/ 2016 with an aortic valve area (AVA) < 1.0cm2 and EF≥ 50%. We followed the 4 flow-gradient subgroups for occurrence of death. Normal flow (NF) was defined as having stroke volume index (SVI) of ≥ 35 ml/m2; while low Flow (LF) was defined as SVI<35. High gradient (HG) was defined as mean gradient of ≥ 40 mmHg; while low gradient (LG) was defined as < 40 mmHg.
A total of 264 patients were included in the analysis with a 1-year follow up. At baseline, there was no significant difference in baseline characteristics in regards to age, race, gender, or baseline characteristics including hypertension, hyperlipidemia, diabetes or coronary artery disease. Comparing all 4 AS subgroups, there was no significant difference in mortality between the groups. (LF/LG 15.7% vs. LF/HG 15.4% vs. NF/HG 7.7% vs. NF/LG 18.8% ; Log Rank Test, P=0.565).
Patients with paradoxical LF/LG and preserved ejection fraction represent an under-recognized high-risk group with similar prognosis to those with HG. TAVR may offer a reasonable option in this group.
STRUCTURAL: Valvular Disease: Aortic