Clin Res Cardiol 101, Suppl 1, April 2012

V1147 - Clinical outcome after transfemoral aortic valve replacement (TAVI) in patients with low-gradient or low-flow aortic stenosis in local anesthesia
S. Fateh-Moghadam1, K. A. L. Müller1, B. Sutaj1, P. Htun1, M. Steeg1, R. Jorbenadze1, M. Gawaz1, W. Bocksch1
1Innere Medizin III, Medizinische Universitätsklinik Tübingen, Tübingen;
Background: Conventional valve replacement in patients with low-gradient (LGAS) or low-flow aortic (LFAS) stenosis  is associated with a high peri- and postoperative mortality. TAVI might represent an alternative treatment option for these patients with LGAS/LFAS.
Aim of the study: The aim of this study was to investigate the clinical outcome of TAVI in patients with LGAS or LFAS.
Methods: From April 2010 till November 2011  in total 120 patients underwent  TAVI at our hospital using the CoreValve Revalving system (26/29mm) in local anesthesia. The CoreValve prothesis was inserted retrograde by 18 F sheath. Of these patients , 15 patients presented with low-flow or low-gradient aortic stenosis (aortic valve area < 1 cm2, mean pressure gradient < 40 mmHg and left ventricular ejection fraction  < 40%. The patients were followed up clinically and by echocardiography. 
Results: At our hospital 105 patients without LGAS/LFAS (age 80.6+0.7 years, log Euroscore 24.5+1.3  ) and 15 patients with LGAS/LFAS (age 78.4+1.5 years, log Euroscore 26.21+3.3  ) with high surgical risk underwent successfully TAVI using the CoreValve  Revalving device. The periprocedural mortality was 0% in both groups.
Patients with LGAS/LFAS (mean aortic gradient 32 +1.7  mmHg, aortic valve area 0.7 + 0.04 cm2 , mean left-ventricular ejection fraction 37 + 3.0 %) had a higher all-cause mortality after TAVI compared to patients without  LGAS/LFAS (mean aortic gradient 46 +1.3  mmHg, aortic valve area 0.7 + 0.04 cm2 , mean left-ventricular  ejection fraction 53 + 2.3 %) . Thirty day mortality was 6.6% in the LGAS/LFAS group versus 3.8% in the other group. After one year survived 12 out of 15 patients with LGAS/LFAS resulting in a mortality of 20%. The longterm mortality in patients without LGAS/LFAS was 11.4% in our cohort. Comparing these results to reported mortalities up to 30%  after surgical aortic valve replacement , these results are quite acceptable for this high-risk group.
Conclusion: TAVI represent a feasible option  for patients with LGAS/LFAS although the mortality is higher compared to patients without LGAS/LFAS but better than after conventional surgical replacement.
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6