TAVR safe and effective for severe AS patients with a very low gradient

Patients were placed into three groups based on their resting aortic mean transvalvular gradient, as determined by transthoracic echocardiography. A high gradient was defined as ≥40 mmHg, a low gradient was defined as 26-39 mmHg and a very low gradient was defined as ≤25 mmHg.

Overall, 57% of patients presented with a high gradient, 35% presented with a low gradient and 8% presented with a very low gradient. Patients with a very low gradient were more likely to present with a comorbidity such as atrial fibrillation, moderate mitral regurgitation and severe mitral regurgitation. These patients also were more symptomatic when presenting for TAVR than patients in the other groups.

After one year, the study’s primary outcome—a composite of all-cause death, a KCCQ-12 score lower than 45 or a decrease in KCCQ-12 score of 10 or more—was seen more in patients with a very low gradient (46.7%) than patients with a high gradient (23.1%) or low gradient (29.9%). However, the team emphasized, this appeared to be due to those higher rates of comorbidities. When making an adjustments for baseline characteristics, there was no longer a significant different between patient groups.

The authors also noted that “most patients” experienced a significant improvement in their KCCQ-12 score, both after 30 days and after one year. There was no difference in improvement between the groups, which suggests patients with a very low gradient can expect results comparable to patients with a low or high gradient.

“Nearly all patients with very-low-gradient severe AS who underwent TAVR had marked improvement in symptoms,” the authors concluded. “Our results suggest that severe symptomatic AS patients benefit from TAVR regardless of baseline mean gradient, though very-low-gradient patients primarily benefit in terms of symptomatic improvement rather than increased survival.”

Read the full analysis here.