Clinical Outcomes in High-Gradient, Classical Low-Flow, Low-Gradient, and Paradoxical Low-Flow, Low-Gradient Aortic Stenosis After Transcatheter Aortic Valve Implantation: A Report From the SwissTAVI Registry.

Wagener, MaxMaxWagenerReuthebuch, OliverOliverReuthebuchHeg, Dierik HansDierik HansHeg0000-0002-8766-7945Tüller, DavidDavidTüllerFerrari, EnricoEnricoFerrariGrünenfelder, JürgJürgGrünenfelderHuber, ChristophChristophHuberMoarof, IgalIgalMoarofMuller, OlivierOlivierMullerNietlispach, FabianFabianNietlispachNoble, StéphaneStéphaneNobleRoffi, MarcoMarcoRoffiTaramasso, MaurizioMaurizioTaramassoTemplin, ChristianChristianTemplinToggweiler, StefanStefanToggweilerWenaweser, PeterPeterWenaweserWindecker, StephanStephanWindeckerStortecky, StefanStefanStorteckyJeger, RabanRabanJeger2024-10-252024-10-252023-06-20https://boris-portal.unibe.ch/handle/20.500.12422/167754Background In view of the rising global burden of severe symptomatic aortic stenosis, its early recognition and treatment is key. Although patients with classical low-flow, low-gradient (C-LFLG) aortic stenosis have higher rates of death after transcatheter aortic valve implantation (TAVI) when compared with patients with high-gradient (HG) aortic stenosis, there is conflicting evidence on the death rate in patients with severe paradoxical low-flow, low-gradient (P-LFLG) aortic stenosis. Therefore, we aimed to compare outcomes in real-world patients with severe HG, C-LFLG, and P-LFLG aortic stenosis undergoing TAVI. Methods and Results Clinical outcomes up to 5 years were addressed in the 3 groups of patients enrolled in the prospective, national, multicenter SwissTAVI registry. A total of 8914 patients undergoing TAVI at 15 heart valve centers in Switzerland were analyzed for the purpose of this study. We observed a significant difference in time to death at 1 year after TAVI, with the lowest observed in HG (8.8%) aortic stenosis, followed by P-LFLG (11.5%; hazard ratio [HR], 1.35 [95% CI, 1.16-1.56]; P<0.001) and C-LFLG (19.8%; HR, 1.93 [95% CI, 1.64-2.26]; P<0.001) aortic stenosis. Cardiovascular death showed similar differences between the groups. At 5 years, the all-cause death rate was 44.4% in HG, 52.1% in P-LFLG (HR, 1.35 [95% CI, 1.23-1.48]; P<0.001), and 62.8% in C-LFLG aortic stenosis (HR, 1.7 [95% CI, 1.54-1.88]; P<0.001). Conclusions Up to 5 years after TAVI, patients with P-LFLG have higher death rates than patients with HG aortic stenosis but lower death rates than patients with C-LFLG aortic stenosis.enSwissTAVI low‐flowlow‐gradient outcomes in aortic stenosis transcatheter aortic valve implantation valvular heart disease600 - Technology::610 - Medicine & healthClinical Outcomes in High-Gradient, Classical Low-Flow, Low-Gradient, and Paradoxical Low-Flow, Low-Gradient Aortic Stenosis After Transcatheter Aortic Valve Implantation: A Report From the SwissTAVI Registry.article10.48350/1833153730176010.1161/JAHA.123.029489