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Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry.
- Source :
-
Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2020 Jul; Vol. 13 (7), pp. e008792. Date of Electronic Publication: 2020 Jul 17. - Publication Year :
- 2020
-
Abstract
- Background: Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe AS may be subdivided in classical low-flow (left ventricular ejection fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular ejection fraction ≥50% but stroke volume index <35 mL/m <superscript>2</superscript> ) and LG; and normal-flow (left ventricular ejection fraction ≥50% and stroke volume index ≥35 mL/m <superscript>2</superscript> ) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups.<br />Methods: A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke.<br />Results: The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% ( P =0.002) and normal-flow-LG: 32.1% ( P =0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% ( P =0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group.<br />Conclusions: The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke at 2 years compared with the HG group. Clinical outcomes were as good in the LG AS groups with preserved left ventricular ejection fraction compared with the HG group.
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Echocardiography, Doppler
Female
Heart Failure etiology
Heart Failure mortality
Heart Failure therapy
Heart Valve Prosthesis
Humans
Male
North America
Patient Readmission
Postoperative Complications etiology
Postoperative Complications mortality
Recovery of Function
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke etiology
Stroke mortality
Time Factors
Treatment Outcome
Aortic Valve surgery
Aortic Valve Stenosis surgery
Heart Valve Prosthesis Implantation adverse effects
Heart Valve Prosthesis Implantation instrumentation
Heart Valve Prosthesis Implantation mortality
Hemodynamics
Ventricular Function, Left
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7632
- Volume :
- 13
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 32674676
- Full Text :
- https://doi.org/10.1161/CIRCINTERVENTIONS.119.008792