Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients
BackgroundWhile there is evidence that patients with low-flow, low-gradient aortic stenosis (AS) benefit from transcatheter aortic valve replacement (TAVR), data are lacking regarding outcomes of patients with a very low gradient (VLG).MethodsIn this retrospective, single-center study of patients wi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1194360/full |
| _version_ | 1797754506463674368 |
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| author | Faisal Rahman Hetal H. Mehta Jon R. Resar Rani K. Hasan Wendy Marconi Hamza Aziz Matthew J. Czarny |
| author_facet | Faisal Rahman Hetal H. Mehta Jon R. Resar Rani K. Hasan Wendy Marconi Hamza Aziz Matthew J. Czarny |
| author_sort | Faisal Rahman |
| collection | DOAJ |
| description | BackgroundWhile there is evidence that patients with low-flow, low-gradient aortic stenosis (AS) benefit from transcatheter aortic valve replacement (TAVR), data are lacking regarding outcomes of patients with a very low gradient (VLG).MethodsIn this retrospective, single-center study of patients with severe AS who underwent TAVR, three groups were defined using baseline mean aortic valve gradient: VLG (≤25 mmHg), low gradient (LG, 26–39 mmHg), and high gradient (HG, ≥40 mmHg). The primary outcome was the composite of Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 of <45, decrease in KCCQ-12 of ≥10 compared with baseline, or death at 1 year.ResultsOne-thousand six patients were included: 571 HG, 353 LG, and 82 VLG. The median age was 82.1 years [interquartile range (IQR) 76.3–86.9]; VLG patients had more baseline comorbidities compared with the other groups. The primary outcome was highest at 1 year in the VLG group (VLG, 46.7%; LG, 29.9%; HG, 23.1%; p = 0.002), with no difference between groups after adjustment for baseline characteristics. At baseline, <30% of VLG patients had an excellent or good (50–100) KCCQ-12, whereas more than 75% and 50% had an excellent or good KCCQ-12 at 30-day and 1-year follow-up, respectively.ConclusionAlthough patients with VLG undergoing TAVR have a higher rate of poor outcomes at 1 year compared with patients with LG and HG severe AS, this difference is largely attributable to baseline comorbidities. Patients with severe AS undergoing TAVR have significant improvement in health status outcomes regardless of resting mean gradient. |
| first_indexed | 2024-03-12T17:34:24Z |
| format | Article |
| id | doaj.art-3444a5f482714141a0f810ed63a64586 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-12T17:34:24Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-3444a5f482714141a0f810ed63a645862023-08-04T12:11:25ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-08-011010.3389/fcvm.2023.11943601194360Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradientsFaisal Rahman0Hetal H. Mehta1Jon R. Resar2Rani K. Hasan3Wendy Marconi4Hamza Aziz5Matthew J. Czarny6Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United StatesDivision of Cardiology, Doylestown Health, Doylestown, PA, United StatesDivision of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United StatesDivision of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United StatesDivision of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United StatesDivision of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, United StatesDivision of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United StatesBackgroundWhile there is evidence that patients with low-flow, low-gradient aortic stenosis (AS) benefit from transcatheter aortic valve replacement (TAVR), data are lacking regarding outcomes of patients with a very low gradient (VLG).MethodsIn this retrospective, single-center study of patients with severe AS who underwent TAVR, three groups were defined using baseline mean aortic valve gradient: VLG (≤25 mmHg), low gradient (LG, 26–39 mmHg), and high gradient (HG, ≥40 mmHg). The primary outcome was the composite of Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 of <45, decrease in KCCQ-12 of ≥10 compared with baseline, or death at 1 year.ResultsOne-thousand six patients were included: 571 HG, 353 LG, and 82 VLG. The median age was 82.1 years [interquartile range (IQR) 76.3–86.9]; VLG patients had more baseline comorbidities compared with the other groups. The primary outcome was highest at 1 year in the VLG group (VLG, 46.7%; LG, 29.9%; HG, 23.1%; p = 0.002), with no difference between groups after adjustment for baseline characteristics. At baseline, <30% of VLG patients had an excellent or good (50–100) KCCQ-12, whereas more than 75% and 50% had an excellent or good KCCQ-12 at 30-day and 1-year follow-up, respectively.ConclusionAlthough patients with VLG undergoing TAVR have a higher rate of poor outcomes at 1 year compared with patients with LG and HG severe AS, this difference is largely attributable to baseline comorbidities. Patients with severe AS undergoing TAVR have significant improvement in health status outcomes regardless of resting mean gradient.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1194360/fulllow-gradient aortic stenosistranscatheter aorta valve replacementpatient outcomesquality of lifevalvular heart disease (VHD) |
| spellingShingle | Faisal Rahman Hetal H. Mehta Jon R. Resar Rani K. Hasan Wendy Marconi Hamza Aziz Matthew J. Czarny Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients Frontiers in Cardiovascular Medicine low-gradient aortic stenosis transcatheter aorta valve replacement patient outcomes quality of life valvular heart disease (VHD) |
| title | Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients |
| title_full | Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients |
| title_fullStr | Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients |
| title_full_unstemmed | Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients |
| title_short | Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients |
| title_sort | outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients |
| topic | low-gradient aortic stenosis transcatheter aorta valve replacement patient outcomes quality of life valvular heart disease (VHD) |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1194360/full |
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