MedStar Authors catalog › Details for: Role of contractile reserve as a predictor of mortality in low-flow, low-gradient severe aortic stenosis following transcatheter aortic valve replacement.
Role of contractile reserve as a predictor of mortality in low-flow, low-gradient severe aortic stenosis following transcatheter aortic valve replacement. Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.Published: ; 2019; ; ISSN: 1522-1946.UI/PMID: 30280469.Subject(s): Aged | *Ventricular Function, Left | *Ventricular Dysfunction, Left/pp [Physiopathology] | Ventricular Dysfunction, Left/mo [Mortality] | Ventricular Dysfunction, Left/dg [Diagnostic Imaging] | Treatment Outcome | *Transcatheter Aortic Valve Replacement/mo [Mortality] | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Time Factors | Stroke Volume | Severity of Illness Index | Risk Factors | Risk Assessment | Retrospective Studies | Recovery of Function | *Myocardial Contraction | Male | Humans | *Hemodynamics | Female | Databases, Factual | *Aortic Valve Stenosis/su [Surgery] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | *Aortic Valve/su [Surgery] | Aortic Valve/pp [Physiopathology] | Aortic Valve/dg [Diagnostic Imaging] | Aged, 80 and overInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1002/ccd.27914 (Click here) Abbreviated citation: ; Catheter Cardiovasc Interv. 93(4):707-712, 2019 03 01.Local Holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006.Abstract: BACKGROUND: Patients with severe AS, left ventricular dysfunction, and low transaortic gradient are at high risk for mortality during surgical aortic valve replacement (SAVR). Furthermore, patients without CR have been shown to have perioperative mortality comparable to that of patients treated medically for severe AS.Abstract: CONCLUSION: In patients with low-flow, low-gradient severe AS undergoing TAVR, the presence or absence of CR does not predict all-cause mortality at 30 days or 1 year.Abstract: Copyright (c) 2018 Wiley Periodicals, Inc.Abstract: METHODS: We retrospectively analyzed patients who underwent TAVR with a diagnosis of low-gradient severe AS (mean transvalvular aortic gradient < 40 mmHg, LVEF < 50%, and AVA <= 1.0 cm<sup>2</sup> or AVAi <= 0.6 cm<sup>2</sup> ) and who had a pre-TAVR dobutamine stress echocardiogram (DSE). Patients were stratified by the presence or absence of CR, defined as an increase in stroke volume >= 20% during DSE.Abstract: OBJECTIVES: The aim of this study was to determine the prognostic value of contractile reserve (CR) at baseline in patients with low-flow, low-gradient severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).Abstract: RESULTS: From 2008 to 2016, 61 patients with low-gradient severe AS underwent TAVR and had pre-TAVR DSE. CR was present in 31 patients (51%) and absent in 30 (49%). There was no significant difference between the two groups in baseline demographics, medical history, access site, or types of valves. All-cause mortality was similar in both groups at 30 days (13% with CR vs 10% without CR, P = 1.00) and 1 year (29% with CR vs 33% without CR, HR 1.20, 95% CI 0.49-2.96, P = 0.69).