| Transcatheter aortic valve implantation in patients with low-flow, low-gradient aortic stenosis. | |
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MedLine Citation:
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PMID: 22625194 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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Alexander Lauten; Ralf Zahn; Martin Horack; Horst Sievert; Axel Linke; Markus Ferrari; Axel Harnath; Eberhard Grube; Ulrich Gerckens; Karl-Heinz Kuck; Stefan Sack; Jochen Senges; Hans R Figulla; |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: JACC. Cardiovascular interventions Volume: 5 ISSN: 1876-7605 ISO Abbreviation: JACC Cardiovasc Interv Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-05-25 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101467004 Medline TA: JACC Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 552-9 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Internal Medicine I, University Heart Center Jena, Jena, Germany. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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