Ballon-expandable Versus Self-expandable Tavr In Low-flow Low-gradient Aortic Valve Stenosis
Lukas Stastny1, Markus Kofler1, Julia Dumfarth1, Christoph Krapf1, Guy Friedrich2, Bernhard Metzler2, Axel Bauer2, Michael Grimm1, Nikolaos Bonaros1.
1Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria, 2Department of Cardiology, Medical University of Innsbruck, Innsbruck, Austria.
BACKGROUND:Patients with low-flow low-gradient (LFLG) aortic stenosis are a highly demanding patient population. In comparison to high gradient aortic stenosis, different calcification patterns with lower valvular calcification mass, volume and asymmetry were observed in this cohort. The aim of this study was to compare the clinical outcome between ballon-expandable and self-expandable valves in low-flow low-gradient aortic valve stenosis. METHODS: From September 2018 to September 2020 216 patients with LFLG aortic stenosis from 2 centers were treated with transcatheter heart valve (THV). A self-expandable valve (SEV) was implanted in 71 (33%) patients and a balloon-expandable valve (BEV) in 145 (67%) patients. Transthoracic echocardiography was repeated at hospital discharge and at 1-year follow-up. RESULTS: There was no difference in preoperative age (SEV 80.25 vs BEV 80.68, p=0.692), STS PROM (SEV 4.26% vs BEV 5.00%, p=687) and mean gradient (SEV 26.91mmHg vs BEV 28.10mmHg, p=0.314). The only preoperative differences were stroke volume index (SEV 23.59ml/m2 vs 27.5ml/m2, p<0.001) and previous pacemaker implantation (SEV 29.6% vs 15.9%, p=0.030). Device success (SEV 94.4% vs 97.2%, p=0.504) and 30-day mortality (SEV 2.8% versus 4.9%, p=0.732) were equal between both groups. New permanent pacemaker implantations were more common after self-expandable valve implantation (19.7% vs 7.6%, p=0.018). There was no difference in moderate/severe paravalvular leakage (SEV 12.5% vs 10.4%, p=0.875). The mean gradient after valve implantation was higher in the BEV group at hospital discharge (SEV 7.25mmHg vs 10.54mmHg, p<0.001) and at 1-year follow-up (SEV 5.57mmHg vs 10.8mmHg, p=0.04). Mortality rate after 1 year was 15.9% in SEV group and 14.3% in the BEV group (p=0.946)
CONCLUSIONS:TAVR can be performed in LFLG AS with low 30-day mortality. Despite the differences in new permanent pacemaker implantation and mean gradient after implantation, the used valve type had neither impact on mortality rate at discharge nor at 1-year follow-up.
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