Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry.

Journal Article

BACKGROUND: Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe AS may be subdivided in classical low-flow (left ventricular ejection fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular ejection fraction ≥50% but stroke volume index <35 mL/m2) and LG; and normal-flow (left ventricular ejection fraction ≥50% and stroke volume index ≥35 mL/m2) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups. METHODS: A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke. RESULTS: The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% (P=0.002) and normal-flow-LG: 32.1% (P=0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% (P=0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group. CONCLUSIONS: The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke at 2 years compared with the HG group. Clinical outcomes were as good in the LG AS groups with preserved left ventricular ejection fraction compared with the HG group.

Full Text

Duke Authors

Cited Authors

  • Salaun, E; Clavel, M-A; Hahn, RT; Jaber, WA; Asch, FM; Rodriguez, L; Weissman, NJ; Gertz, ZM; Herrmann, HC; Dahou, A; Annabi, M-S; Toubal, O; Bernier, M; Beaudoin, J; Leipsic, J; Blanke, P; Ridard, C; Ong, G; Rodés-Cabau, J; Webb, JG; Zhang, Y; Alu, MC; Douglas, PS; Makkar, R; Miller, DC; Lindman, BR; Thourani, VH; Leon, MB; Pibarot, P

Published Date

  • July 2020

Published In

Volume / Issue

  • 13 / 7

Start / End Page

  • e008792 -

PubMed ID

  • 32674676

Pubmed Central ID

  • 32674676

Electronic International Standard Serial Number (EISSN)

  • 1941-7632

Digital Object Identifier (DOI)

  • 10.1161/CIRCINTERVENTIONS.119.008792

Language

  • eng

Conference Location

  • United States