Transcatheter Aortic Valve Replacement in Patients With Low-Flow, Low-Gradient Aortic Stenosis
| Autor: | Josep Rodés-Cabau, Ignacio J. Amat-Santos, Tarun Chakravarty, Mélanie Côté, Bruno García del Blanco, Alberto de Agustín, Florent Le Ven, Wilson Y. Szeto, Asim N. Cheema, Thomas G. Gleason, Luis Nombela-Franco, Howard C. Herrmann, Raj Makkar, Rishi Puri, John Lisko, Stephan Windecker, Alan Zajarias, Henrique Barbosa Ribeiro, John Schindler, Stamatios Lerakis, Marie-Annick Clavel, Antonio J. Muñoz-García, Vicenç Serra, Philippe Pibarot, Martine Gilard, Salim S. Hayek, João L. Cavalcante, Maurice Enriquez-Sarano, Emilie Pelletier-Beaumont, Vasilis C. Babaliaros, Abdellaziz Dahou |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Ejection fraction medicine.diagnostic_test business.industry medicine.medical_treatment Stroke volume 030204 cardiovascular system & hematology Doppler echocardiography medicine.disease 03 medical and health sciences Stenosis 0302 clinical medicine Valve replacement Interquartile range Internal medicine Aortic valve stenosis medicine Cardiology Dobutamine 030212 general & internal medicine Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 71:1297-1308 |
| ISSN: | 0735-1097 |
| Popis: | Background Few data exist on patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR). Also, very scarce data exist on the usefulness of dobutamine stress echocardiography (DSE) before TAVR in these patients. Objectives The authors sought to evaluate clinical outcomes and changes in left ventricular ejection fraction (LVEF) following TAVR in patients with classical LFLG-AS. Methods This multicenter registry included 287 patients with LFLG-AS undergoing TAVR. DSE was performed before TAVR in 234 patients and the presence of contractile reserve was defined as an increase of ≥20% in stroke volume. Transthoracic echocardiography was repeated at hospital discharge and at 1-year follow-up. Clinical follow-up was obtained at 1 and 12 months, and yearly thereafter. Results The median Society of Thoracic Surgeons score of the study population was 7.7% (interquartile range 5.3% to 12.0%), and the mean LVEF and transvalvular gradient were 30.1 ± 9.7% and 25.4 ± 6.6 mm Hg, respectively. The presence of contractile reserve was observed in 45% of patients at DSE. Mortality rates were 3.8%, 20.1%, and 32.3% at 30 days, 1 year, and 2 years, respectively. On multivariable analysis, chronic obstructive pulmonary disease (p = 0.022) and lower hemoglobin values (p Conclusions TAVR was associated with good periprocedural outcomes in patients with LFLG-AS. However, approximately one-third of LFLG-AS TAVR recipients died at 2-year follow-up, with pulmonary disease, anemia, and residual paravalvular leaks associated with poorer outcomes. LVEF improved following TAVR, but DSE failed to predict clinical outcomes or LVEF changes over time. (Multicenter Prospective Study of Low-Flow Low-Gradient Aortic Stenosis [TOPAS Study]; NCT01835028) |
| Databáze: | OpenAIRE |
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