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Minerva Medica 2021 June;112(3):322-8

DOI: 10.23736/S0026-4806.20.06817-2


language: English

How low is “low-flow” in aortic stenosis? A retrospective analysis of patients with true low-flow/low-gradient aortic stenosis undergoing TAVI

Tanja KÜCKEN 1, 2 , Christoph EDLINGER 1, 2, 3, Maki OKAMOTO 1, 2, Marwin BANNEHR 1, 2, Peter JIRAK 3, Michael LICHTENAUER 3, Anja HAASE-FIELITZ 1, 2, Florian KRIZANIC 4, Christian BUTTER 1, 2

1 Department of Cardiology, Heart Center Brandenburg, Bernau bei Berlin, Germany; 2 Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany; 3 Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria; 4 Department of Cardiology, Caritas Clinic Pankow Berlin, Berlin, Germany

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a valuable treatment option for patients with reduced left ventricular ejection fraction (LVEF) and low-flow/low-gradient (LF/LG) aortic stenosis (AS). According to current literature, the presence of severe AS is unlikely in case of severely reduced LVEF and mean pressure gradient (meanPG) below 30 mmHg. However, a considerable number of patients presenting with typical clinical symptoms of severe AS, show gradients below 30 mmHg. We hypothesized, that these patients undergoing TAVI do have a measurable clinical benefit and an improved LVEF.
METHODS: In this single center retrospective cohort study, data from 1199 patients undergoing TAVI between 2013 and 2017 was analyzed. A 6-month follow-up was performed to assess changes in NT-proBNP, NYHA-class, and LVEF.
RESULTS: Thirty patients presented with LVEF<35%, an aortic valve area (AVA<1 cm2), and a meanPG below 30 mmHg. Mean logistic EuroSCORE II was 24.05±10.9. Most patients (56%) showed improved NYHA-class upon follow-up. NT-proBNP-levels decreased from 3.901 pg/mL IQR 10.880 to 1.491 pg/mL IQR 2.245 (P<0.001). LVEF increased from 30% IQR 6.25 to 40% IQR 15 (P<0.001).
CONCLUSIONS: Based on our findings TAVI represents a valuable treatment option even in patients with LF/LG AS and PGmean below 30mmHg.

KEY WORDS: Aortic valve stenosis; Transcatheter aortic valve replacement; Stroke volume

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