Media type: E-Article Title: Clinical presentation and outcomes after transcatheter aortic valve implantation in patients with low flow/low gradient severe aortic stenosis Contributor: Elhmidi, Yacine; Piazza, Nicolo; Krane, Markus; Deutsch, Marcus‐André; Mazzitelli, Domenico; Lange, Rüdiger; Bleiziffer, Sabine Published: Wiley, 2014 Published in: Catheterization and Cardiovascular Interventions, 84 (2014) 2, Seite 283-290 Language: English DOI: 10.1002/ccd.25366 ISSN: 1522-1946; 1522-726X Origination: Footnote: Description: ObjectivesTo identify predictors of mortality, functional status, and hemodynamical changes of patients undergoing transcatheter aortic valve implantation (TAVI) for low flow/low gradient aortic stenosis (LF/LG AS).BackgroundThere is little published data regarding the outcomes of patients with LF/LG AS following TAVI.MethodsSixty‐eight patients with severe AS, left ventricular dysfunction (ejection fraction [EF] <35%) and low flow (LF) AS underwent TAVI. Patients were stratified according to the aortic mean pressure gradient (low gradient [LG]; with Pmean ≤40 mm Hg and high gradient [HG]: Pmean >40 mm Hg). The baseline parameters and clinical outcomes were subsequently compared among the two groups. Cox proportional hazards were used to identify predictors of 6‐month mortality.ResultsThere were 38 patients in the LG group and 30 patients in the HG group. There were no significant difference in 30‐day mortality between the two groups. The 6‐month and 1‐year mortality, however, was 3.8‐fold and 2.8‐fold higher in the LG group than in the HG group (37.8% vs. 10.3%, P = 0.01 and 37.8% vs. 13.3%, respectively, P = 0.01). Univariable predictors for 6‐month mortality were: STS Score, aortic valve area, and aortic mean pressure gradient. However, only STS Score (HR 1.08, 1.04–1.12, P < 0.001) remained as independent predictor in the multivariable analysis. Six months after TAVI, hemodynamical (EF > 50%) and clinical (NYHA class I) improvements were shown in both HG and LG groups.ConclusionsLF/LG AS does not influence procedural mortality after TAVI but exhibits a strong impact on 6‐month and 1‐year mortality. The survivors, however, exhibit considerable hemodynamical and clinical improvements. Therefore, risk stratification and TAVI benefit should be weighted in every patient with LF/LG AS. © 2014 Wiley Periodicals, Inc.