Al-Bayati Asseel, Alrifai Abdullah, Darmoch Fahed, Alkhaimy Haytham, Fanari Zaher
University of California San Francisco, Fresno, CA, USA.
Advocate Aurora Health, Chicago, IL, USA.
Cardiovasc Revasc Med. 2025 Apr;73:1-7. doi: 10.1016/j.carrev.2024.07.020. Epub 2024 Jul 27.
The outcome of Low Flow-Low Gradient (LF-LG) severe aortic stenosis (AS) patients who underwent Transcatheter Aortic Valve Replacement (TAVR) procedure is not well defined. We conducted a systematic review of the literature to compare the outcomes of TAVR in LF-LG AS patients to the more traditional high gradient (HG) aortic stenosis.
We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We are presenting the data using risk ratios (95 % confidence intervals) and measuring heterogeneity using Higgins' I index.
Our analysis included 4380 patients with 3425 HG patients and 955 LF-LG patients from 6 cohort (5 retrospective and 1 prospective) studies. When compared to LFLG; TAVR was associated with significantly lower 30 days mortality in HG patients (5.1 % vs 7.4 %; relative risk [RR]: 0.55; 95 % confidence interval [CI]: 0.35 to 0.86; p < 0.01). Similar findings were also observed in 12-month cardiovascular (CV) mortality (5.5 % vs. 10.4 %; RR: 0.47; 95 % CI: 0.38 to 0.60; p < 0.01 and 12-month all-cause mortality (15.9 % vs 20.9 %; RR: 0.70; 95 % CI: 0.49 to 1.00; p < 0.05). There was no significant difference in myocardial infarction (MI) after TAVR between HG and LF-LG at 30 days (0.16 % vs. 0.95 %; p < 0.09) or 12 months (0.43 % vs. 0.95 %; p = 0.20). Similarly, there was no difference in stroke rates at 30 days (2.9 % vs. 2.86 %) or at 12 months (3.6 % vs. 3.06 %).
Patients with LF-LG severe AS who underwent TAVR had worse 1-year all-cause mortality, 30-day all-cause, and 1-year CV mortality when compared to TAVR in HG severe AS. There was no difference in MI or stroke rates. Therefore, with heart team discussion and informed patient decision regarding the risk and benefit, TAVR would still offer better outcomes in LFLG AS compared to conservative medical management.
接受经导管主动脉瓣置换术（TAVR）的低流量-低梯度（LF-LG）重度主动脉瓣狭窄（AS）患者的预后尚不明确。我们对文献进行了系统回顾，以比较LF-LG AS患者TAVR的预后与更传统的高梯度（HG）主动脉瓣狭窄的预后。
我们全面检索了4个在线数据库中的对照随机和非随机研究。我们使用风险比（95%置信区间）呈现数据，并使用希金斯I指数测量异质性。
我们的分析纳入了来自6项队列研究（5项回顾性研究和1项前瞻性研究）的4380例患者，其中3425例HG患者和955例LF-LG患者。与LF-LG相比；TAVR与HG患者30天死亡率显著降低相关（5.1%对7.4%；相对风险[RR]：0.55；95%置信区间[CI]：0.35至0.86；p<0.01）。在12个月心血管（CV）死亡率（5.5%对10.4%；RR：0.47；95%CI：0.38至0.60；p<0.01）和12个月全因死亡率（15.9%对20.9%；RR：0.70；95%CI：0.49至1.00；p<0.05）中也观察到类似结果。HG和LF-LG患者TAVR后30天（0.16%对0.95%；p<0.09）或12个月（0.43%对0.95%；p=0.20）的心肌梗死（MI）无显著差异。同样，30天（2.9%对2.86%）或12个月（3.6%对3.06%）的卒中发生率也无差异。
与HG重度AS患者的TAVR相比，接受TAVR的LF-LG重度AS患者1年全因死亡率及30天全因和1年CV死亡率更差。MI或卒中发生率无差异。因此，经心脏团队讨论并让患者充分了解风险和获益后做出决定，与保守药物治疗相比，TAVR在LF-LG AS患者中仍能提供更好的预后。
