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Brain & Heart TAVR in low gradient aortic stenosis

Table 2. (Continued)
First author, Year Study design Objective Number of patients/studies Outcome
included
class III – IV and exhibited a
higher rate of cardiovascular
complications. TAVI treatment
futility was more frequent in
the pLFLGAS group.
Ozkan et al., 2013 83 Prospective study Comparing the outcomes of severe 260 patients AVR was associated with
LGAS with those of AVR and medical better survival rates than
therapy. medical therapy in patients
with symptomatic LGAS and
preserved EF.
Kugelman et al., A prospective Comparison of outcomes in patients 130 patients Patients with LGAS exhibited
2020 84 observational study with LGAS who underwent TAVR and better adjusted event-free
those with LGAS who underwent SAVR. survival when referred to TAVR
rather than to SAVR.
Annabi et al., 2020 85 A prospective To compare the outcomes in patients 481 patients Early AVR was associated
observational study with LFLGAS who were treated with with major survival benefits in
surgical AVR, transfemoral TAVR, both classic and paradoxical
alternate access TAVR, and conservative LFLGAS. Compared with
management. conservative management,
transfemoral TAVR exhibited
the best survival rate, followed
by surgical AVR and alternative
access TAVR.
Abbreviations: AS: Aortic stenosis; AVR: Aortic valve replacement; CLFLGAS: Classic low-flow: EF: Ejection fraction; KCCQ: Kansas City
Cardiomyopathy Questionnaire; LFLGAS: Low-flow, Low-gradient aortic stenosis; LVEF: Left ventricular ejection fraction; MR: Mitral regurgitation;
NFHGAS: Normal-flow, high-gradient aortic stenosis; NYHA: New York Heart Association class; pLFLGAS: Paradoxical low-flow, low-gradient aortic
stenosis; SAVR: Surgical aortic valve replacement; TAVI: Transcatheter aortic valve implantation; TAVR: Transcatheter aortic valve replacement.

SAVR demonstrated improved survival at 1 year compared when outcomes were compared among patients who
with medical therapy. After 28 months of follow-up, received early AVR and those who received conservative
89
patients with pLFLGAS who underwent TAVR or SAVR management, AVR was associated with a significant survival
had an improved survival rate compared with those who benefit in both patients with cLFLGAS and pLFLGAS.
underwent balloon aortic valvuloplasty or medical therapy. Among the AVR types, TF TAVR was associated with the
Specifically, the survival rates were 30% in patients who best survival, as compared to conservative management. In
85
underwent AVR and 70% in medically treated patients. an observational study, the outcomes of patients with LGAS
Most of these patients, however, underwent SAVR. undergoing TAVR or SAVR were compared over 4 years of
83
However, in the multicenter ROTAS trial, 52 patients with follow-up. There was no difference seen in rates of overall
pLFLGAS were randomized to undergo AVR (TAVR or survival, long-term dialysis or urgent rehospitalization, or
SAVR) or optimized medical therapy. After 14 months survival free of stroke. However, TAVR was associated with
of follow-up, death and heart failure hospitalization were a better-adjusted event-free survival. 84
comparable in both groups. 90 Compared with the HGAS group, the LFLGAS

Although most studies comparing AVR with conservative group exhibited increased mortality and morbidity after
or medical management involve both SAVR and TAVR, undergoing TAVR. However, enough data suggests that
certain findings and studies are also specific to TAVR. TAVR is a beneficial option over conservative management
In a trial comparing outcomes in 1358 patients with and, in certain respects, possibly over SAVR, for patients
NFLGAS undergoing TAVR or SAVR versus conservative with LFLGAS in the long term. Given their poor known
management, at 652 days, TAVR was associated with outcomes, these patients should be more closely monitored
improved survival and decreased cardiac mortality as compared with patients with HGAS. Apart from AVR,
compared to conservative management. Furthermore, medical optimization should be pursued aggressively to
there was no significant difference between the outcomes prevent hospitalization for decompensated heart failure
of SAVR versus TAVR. In the TOPAS prospective study, and to enhance other clinical outcomes.
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Volume 3 Issue 1 (2025) 13 doi: 10.36922/bh.4017