Outcome of Patients with Low-gradient Aortic Stenosis Undergoing Transcatheter or Surgical Aortic Valve Replacement - The 66th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery

Netta Kugelman ¹ Ronen Jaffe ^1,2 Doron Aronson ^1,4 Erez Sharoni ^1,3 Salim Adawi ^1,2 Nader Khader ² Avinoam Shiran ^1,2

¹Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology
²Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center
³Department of Cardiothoracic Surgery, Lady Davis Carmel Medical Center
⁴Cardiology, Rambam Medical Center

Background: Patients with low-gradient (LG) severe aortic stenosis (AS) have worse outcome following surgical aortic valve replacement (SAVR) than patients with high-gradient AS. We hypothesized that transcatheter aortic valve replacement (TAVR) may be a better treatment option for these patients.

The aim of this study was to compare outcomes of patients with LG AS referred for TAVR and SAVR.

Methods: We studied consecutive patients with LG AS who underwent TAVR between 2010-2016 or SAVR between 2005-2015. Inclusion criteria included aortic valve area (AVA) ≤1 cm², mean aortic valve pressure gradient

Results: LG AS was present in 50 patients who underwent TAVR (age: 81±6 years, 50% females) and 80 patients who underwent SAVR (age: 76±7 years, 35% females). Over 4 years of follow-up there was no difference in event-free survival (Figure) and overall survival between patients undergoing TAVR or SAVR (12% and 61% vs. 19% and 67%, p=0.9 and 0.8, respectively), even though TAVR patients were significantly older, had more comorbidities and had a higher EuroSCORE Ⅱ. After adjustment for these covariates, TAVR was associated with better event-free survival (adjusted HR: 0.63, 95% CI 0.40-0.97, p=0.044).

Conclusion: Patients with LG AS had better adjusted event-free survival when referred to TAVR rather than to SAVR.