One-Year Outcomes Of Paradoxical Low Flow Severe Aortic Stenosis, Post TAVR.

Randhawa, Mandeep

One-Year Outcomes Of Paradoxical Low Flow Severe Aortic Stenosis, Post TAVR.

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Mandeep S Randhawa, MD , Michigan State University, East Lansing, MI

Yehia Saleh, MD , Michigan State University, East Lansing, MI

Khader Herzallah, MD , Michigan State University, East Lansing, MI

Sherif Elkinany, MD , Michigan State University, East Lansing, MI

Abdallah Almaghraby , Alexandria University, Alexandria, Egypt

Amritpal K Randhawa, MBBS , Michigan State University, East Lansing, MI

Miriam Glardon, RN , Sparrow Clinical Research Institute, Lansing, MI

Gaurav Dhar, MD , Thoracic and Cardiovascular Institute, Okemos, MI

Background:
The management of the symptomatic low gradient severe aortic stenosis (AS) with preserved ejection fraction (paradoxical low flow severe AS) is still evolving. We sought to describe the immediate and one-year outcomes of these patients post TAVR.

Methods:
Consecutive 40 patients with peak gradient <40 mmHg, EF >50% and aortic area <1 cm²who underwent TAVR were compared with 148 patients with peak gradient >40 mmHg and preserved EF who underwent TAVR over the same period.

Results:
The paradoxical low flow AS patients average age was 82±9; 22 (55%) were female with mean EF of 59.6%. The high gradient AS patients average age was also 82±9 with 77 (52%) female and average EF of 59.4%. At 30 days, paradoxical low flow AS patients, mortality was 1(2.5%), needed permanent pacemaker in 5(12.5%) patients; whereas in high gradient AS mortality was 9 (6%, p=0.03) and permanent pacemaker was needed in 16 (10.8%, p=0.71) patients. At 1 year, paradoxical low flow AS patients had 1(2.5%) stroke, mortality was 3 (7.5%) and had 6 (15%) re- hospitalization, whereas high gradient AS had 3 (2%, p=0.91) strokes, 16 (11%, p=0.23) deaths and 6 (4%, p =0.07) re-hospitalizations.

Conclusions:
Post TAVR, patients with paradoxical low flow severe AS have comparable mortality at one year, with a trend towards a higher rate of re-hospitalization when compared with high gradient AS patients.