Prognostic Implications of Very Low‐Gradient Aortic Stenosis After Transcatheter Aortic Valve Implantation: Insights From the OCEAN‐TAVI Registry

Background The management of very low‐gradient (LG) severe aortic stenosis (AS) remains challenging. Moreover, limited evidence exists regarding the outcomes of patients with very LG severe AS following transcatheter aortic valve implantation (TAVI). Aims We aimed to elucidate the prognosis of patients with very LG severe AS after TAVI and the influence of flow status. Methods Data were retrospectively collected from the OCEAN‐TAVI multicenter registry in Japan, including patients with severe AS who underwent TAVI. Results In total, 7103 patients were classified into three groups based on their baseline mean pressure gradient (MPG): very LG (MPG ≤ 20 mmHg), LG (20 < MPG < 40 mmHg), and high‐gradient (HG) (MPG ≥ 40 mmHg). The primary endpoint was a composite of all‐cause mortality and hospitalization for heart failure. During a median follow‐up period of 741 days, the composite endpoint was reached in 2081 patients. Patients with very LG severe AS had a higher prevalence of comorbidities. Kaplan–Meier analysis showed that very LG severe AS was associated with significantly lower event‐free survival compared to that with LG and HG severe AS. Multivariable Cox regression analysis identified very LG severe AS as an independent poor prognostic indicator, regardless of the flow state. Moreover, within the very LG severe AS group, a low body mass index and myocardial infarction history were associated with worse outcomes. Conclusion This study indicates that patients with very LG severe AS have worse prognoses compared to those with LG or HG severe AS following TAVI, regardless of the flow state.