Role of contractile reserve as a predictor of mortality in low-flow, low-gradient severe aortic stenosis following transcatheter aortic valve replacement.
- 2019
Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006
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. 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. Copyright (c) 2018 Wiley Periodicals, Inc. 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 cm2 or AVAi <= 0.6 cm2 ) 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. 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). 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).
English
1522-1946
*Aortic Valve Stenosis/su [Surgery] *Aortic Valve/su [Surgery] *Hemodynamics *Myocardial Contraction *Transcatheter Aortic Valve Replacement/mo [Mortality] *Ventricular Dysfunction, Left/pp [Physiopathology] *Ventricular Function, Left Aged Aged, 80 and over Aortic Valve Stenosis/dg [Diagnostic Imaging] Aortic Valve Stenosis/mo [Mortality] Aortic Valve Stenosis/pp [Physiopathology] Aortic Valve/dg [Diagnostic Imaging] Aortic Valve/pp [Physiopathology] Databases, Factual Female Humans Male Recovery of Function Retrospective Studies Risk Assessment Risk Factors Severity of Illness Index Stroke Volume Time Factors Transcatheter Aortic Valve Replacement/ae [Adverse Effects] Treatment Outcome Ventricular Dysfunction, Left/dg [Diagnostic Imaging] Ventricular Dysfunction, Left/mo [Mortality]