Outcomes and Predictors of Flow Improvement After Transcatheter Aortic Valve Replacement in Patients With Low-Flow Low-Gradient Aortic Stenosis.

BACKGROUND

Flow is known to typically improve after transcatheter aortic valve replacement (TAVR); however, the characteristics correlating with improvement are still unclear. This study sought to explore the outcomes of patients with low-flow low-gradient aortic stenosis (LFLG AS) and flow improvement following TAVR compared to those without flow improvement, in addition to the predictors of flow improvement.

METHODS

This is a retrospective cohort of patients >18 years of age who underwent TAVR at Cleveland Clinic between 2016 and 2020. Only patients with aortic valve area <1 cm, aortic valve mean gradient <40 mmHg, and stroke volume index (SVI) ​<35 mL/m were included. Patients were classified into 2 groups according to whether SVI improved by 20% or more at the 30-day follow-up. Patients who underwent valve-in-valve TAVR were excluded. Binary logistic regression was used to evaluate the predictors of flow improvement.

RESULTS

A total of 633 patients had LFLG AS. Two hundred twenty-eight patients (36%) had SVI improvement by 20% or more. Male sex, left ventricular ejection fraction (LVEF) improvement by 10% or more 30 days post-TAVR, lower baseline SVI and paradoxical LFLG AS predicted flow improvement. There was no difference in mortality and heart failure rehospitalization between patients with and without flow improvement.

CONCLUSIONS

One-third of patients with LFLG AS show an improvement in flow post-TAVR. Paradoxical LFLG AS, male sex, lower baseline SVI, and improvement in LVEF correlated with flow improvement, whereas baseline LVEF did not. There was no difference in clinical outcomes between patients with and without flow improvement post-TAVR.