Alexander Lauten1, Ralf Zahn2, Martin Horack3, Horst Sievert4, Axel Linke5, Markus Ferrari6, Axel Harnath7, Eberhard Grube8, Ulrich Gerckens9, Karl-Heinz Kuck10, Stefan Sack11, Jochen Senges3, Hans R Figulla6. 1. Department of Internal Medicine I, University Heart Center Jena, Jena, Germany. Electronic address: alexander.lauten@med.uni-jena.de. 2. Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany. 3. Institut fuer Herzinfarktforschung, Ludwigshafen, Germany. 4. CardioVascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany. 5. Department of Cardiology, Herzzentrum Leipzig, Leipzig, Germany. 6. Department of Internal Medicine I, University Heart Center Jena, Jena, Germany. 7. Department of Cardiology, Sana-Herzzentrum Cottbus, Cottbus, Germany. 8. Medizinische Klinik II, Universitaetsklinikum Bonn, Bonn, Germany. 9. Department of Cardiology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany. 10. Department of Cardiology, Asklepios Klinik St. Georg, Hanseatic Heart Center Hamburg, Hamburg, Germany. 11. Department of Cardiology, Klinikum Muenchen Schwabing, Munich, Germany.
Abstract
OBJECTIVES: The purpose of this study was to evaluate the efficacy and outcome of transcatheter aortic valve implantation (TAVI) in patients with low-flow, low-gradient aortic stenosis (LG-AS). BACKGROUND: Patients with LG-AS have a poor prognosis with medical treatment and a high risk for surgical aortic valve replacement. METHODS: Between January 2009 and June 2010, a total of 1,302 patients underwent TAVI for severe AS and were prospectively included in the multicenter German TAVI registry. RESULTS: LG-AS was present in 149 patients (11.4%; mean age: 80.2 ± 6.3 years). In this subgroup, the EuroSCORE was significantly higher (26.8 ± 16.6 vs. 20.0 ± 13.3; p < 0.0001) compared with patients with high-gradient AS (HG-AS). The procedural success rate (LG-AS: 95.3% vs. HG-AS: 97.5%; p = 0.13) and the rate of TAVI-associated complications were comparable in both groups (new pacemaker: 27.0% vs. 28.1%; p = 0.76; cerebrovascular events: 3.4% vs. 3.1%, p = 0.83). However, post-operative low-output syndrome occurred more frequently in the LG-AS-group (LG-AS: 14.9% vs. HG-AS: 5.7%, p < 0.0001), and mortality at 30 days and 1 year was significantly higher in this subgroup (LG-AS: 12.8% and 36.9% vs. HG-AS: 7.4% and 18.1%; p < 0.001 and p < 0.0001, respectively). Post-operative New York Heart Association functional class improved, and self-assessed quality of life increased significantly, demonstrating a substantial benefit in the LG-AS group at 30 days and 1 year after TAVI. CONCLUSIONS: In high-risk patients with LG-AS, TAVI is associated with a significantly higher mortality at 30 days and at 1 year. However, long-term survivors benefit from TAVI with functional improvement and a significantly increased quality of life. Therefore, in view of the poor prognosis with medical treatment, TAVI should be considered an option in high-risk patients with LG-AS.
OBJECTIVES: The purpose of this study was to evaluate the efficacy and outcome of transcatheter aortic valve implantation (TAVI) in patients with low-flow, low-gradient aortic stenosis (LG-AS). BACKGROUND:Patients with LG-AS have a poor prognosis with medical treatment and a high risk for surgical aortic valve replacement. METHODS: Between January 2009 and June 2010, a total of 1,302 patients underwent TAVI for severe AS and were prospectively included in the multicenter German TAVI registry. RESULTS: LG-AS was present in 149 patients (11.4%; mean age: 80.2 ± 6.3 years). In this subgroup, the EuroSCORE was significantly higher (26.8 ± 16.6 vs. 20.0 ± 13.3; p < 0.0001) compared with patients with high-gradient AS (HG-AS). The procedural success rate (LG-AS: 95.3% vs. HG-AS: 97.5%; p = 0.13) and the rate of TAVI-associated complications were comparable in both groups (new pacemaker: 27.0% vs. 28.1%; p = 0.76; cerebrovascular events: 3.4% vs. 3.1%, p = 0.83). However, post-operative low-output syndrome occurred more frequently in the LG-AS-group (LG-AS: 14.9% vs. HG-AS: 5.7%, p < 0.0001), and mortality at 30 days and 1 year was significantly higher in this subgroup (LG-AS: 12.8% and 36.9% vs. HG-AS: 7.4% and 18.1%; p < 0.001 and p < 0.0001, respectively). Post-operative New York Heart Association functional class improved, and self-assessed quality of life increased significantly, demonstrating a substantial benefit in the LG-AS group at 30 days and 1 year after TAVI. CONCLUSIONS: In high-risk patients with LG-AS, TAVI is associated with a significantly higher mortality at 30 days and at 1 year. However, long-term survivors benefit from TAVI with functional improvement and a significantly increased quality of life. Therefore, in view of the poor prognosis with medical treatment, TAVI should be considered an option in high-risk patients with LG-AS.
Authors: Anna Selle; Hans R Figulla; Markus Ferrari; Wilma Rademacher; Bjoern Goebel; Ali Hamadanchi; Marcus Franz; Andrea Schlueter; Thomas Lehmann; Alexander Lauten Journal: Clin Res Cardiol Date: 2014-06-05 Impact factor: 5.460
Authors: Maroun Yammine; Fernando Ramirez-Del Val; Julius I Ejiofor; Robert C Neely; Diana Shi; Siobhan McGurk; Sary F Aranki; Tsuyoshi Kaneko; Prem S Shekar Journal: Ann Cardiothorac Surg Date: 2017-09
Authors: X Luo; Z Zhao; H Chai; C Zhang; Y Liao; Q Li; Y Peng; W Liu; X Ren; Q Meng; C Chen; M Chen; Y Feng; D Huang Journal: Herz Date: 2015-02-26 Impact factor: 1.443