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Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry.

by Asch, Federico M; Weissman, Neil J.
Citation: Circulation: Cardiovascular Interventions. 13(7):e008792, 2020 Jul..Journal: Circulation. Cardiovascular interventions.Published: ; 2020ISSN: 1941-7640.Full author list: Salaun E; Clavel MA; Hahn RT; Jaber WA; Asch FM; Rodriguez L; Weissman NJ; Gertz ZM; Herrmann HC; Dahou A; Annabi MS; Toubal O; Bernier M; Beaudoin J; Leipsic J; Blanke P; Ridard C; Ong G; Rodes-Cabau J; Webb JG; Zhang Y; Alu MC; Douglas PS; Makkar R; Miller DC; Lindman BR; Thourani VH; Leon MB; Pibarot P.UI/PMID: 32674676.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1161/CIRCINTERVENTIONS.119.008792 (Click here) Abbreviated citation: Circ., Cardiovasc. interv.. 13(7):e008792, 2020 Jul.Abstract: BACKGROUND: Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe AS may be subdivided in classical low-flow (left ventricular ejection fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular ejection fraction >=50% but stroke volume index <35 mL/m2) and LG; and normal-flow (left ventricular ejection fraction >=50% and stroke volume index >=35 mL/m2) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups.Abstract: METHODS: A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke.Abstract: RESULTS: The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% (P=0.002) and normal-flow-LG: 32.1% (P=0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% (P=0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group.Abstract: CONCLUSIONS: The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke at 2 years compared with the HG group. Clinical outcomes were as good in the LG AS groups with preserved left ventricular ejection fraction compared with the HG group.

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