Effect of low-flow, very low-gradient aortic stenosis on survival and objective functional recovery after TAVI

INTRODUCTION AND OBJECTIVES: It is unclear how the magnitude of reductions in baseline mean aortic gradient and flow affects clinical outcomes after TAVI. This study aimed to assess the prognostic impact of low-flow very low-gradient (LF-VLG) aortic stenosis on survival and objective functional recovery after TAVI. METHODS: Data from the Spanish TAVI Registry were analyzed. Three groups were included: high-gradient (≥ 40 mmHg), low-flow low-gradient (LF-LG) (20-39 mmHg) and LF-VLG (≤ 20 mmHg). A prospective single-center substudy was conducted to evaluate objective functional recovery after TAVI. RESULTS: A total of 17 836 patients were included. Two-year survival was 82% in the high-gradient group (n = 12 800), 79% in the LF-LG group (n = 4126), and 73.2% in the LF-VLG group (n = 495) (P < .0001). In patients with LF-VLG, coronary artery disease and atrial fibrillation, but not ejection fraction, independently predicted mortality. In a cohort of 465 patients, objective improvement was observed in 88% of patients in the high-gradient group, 70% in the LF-LG group, and 57% in the LF-VLG group (P < .0001). CONCLUSIONS: Patients with LF-VLG aortic stenosis show reduced but acceptable 2-year survival regardless of ejection fraction and limited functional recovery at 6 months after TAVI. Coronary artery disease and atrial fibrillation were independent predictors of mortality.