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

Publication ,  Journal Article
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 ...
Published in: Circ Cardiovasc Interv
July 2020

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.

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Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

e008792

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Registries
  • Recovery of Function
  • Postoperative Complications
 

Citation

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Salaun, E., Clavel, M.-A., Hahn, R. T., Jaber, W. A., Asch, F. M., Rodriguez, L., … Pibarot, P. (2020). Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry. Circ Cardiovasc Interv, 13(7), e008792. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008792
Salaun, Erwan, Marie-Annick Clavel, Rebecca T. Hahn, Wael A. Jaber, Federico M. Asch, Leonardo Rodriguez, Neil J. Weissman, et al. “Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry.Circ Cardiovasc Interv 13, no. 7 (July 2020): e008792. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008792.
Salaun E, Clavel M-A, Hahn RT, Jaber WA, Asch FM, Rodriguez L, et al. Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry. Circ Cardiovasc Interv. 2020 Jul;13(7):e008792.
Salaun, Erwan, et al. “Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry.Circ Cardiovasc Interv, vol. 13, no. 7, July 2020, p. e008792. Pubmed, doi:10.1161/CIRCINTERVENTIONS.119.008792.
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. Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry. Circ Cardiovasc Interv. 2020 Jul;13(7):e008792.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

e008792

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Registries
  • Recovery of Function
  • Postoperative Complications