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Brain & Heart

REVIEW ARTICLE
A contemporary review of transcatheter aortic

valve replacement in low-gradient aortic
stenosis

Muhammad Majid 1,2 , Akiva Rosenzveig 1 , Elio Haroun 1 ,
Aro Daniela Arockiam 1 , Ankit Agrawal 1 , Sharmeen Sorathia 1 ,
Rochell Issa 1 , Tiffany Dong 1 , Nithila Sivakumar 1 , and
Tom Kai Ming Wang *
1
1 Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Heart, Vascular and
Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
2 Department of Internal Medicine, Advent Health Sebring, Sebring, Florida, United States of America
(This article belongs to the Special Issue: Structural Heart Disease: Recent Updates)

Abstract

Transcatheter aortic valve replacement (TAVR) has been approved for patients
with severe symptomatic aortic stenosis (AS) across the spectrum of surgical risk.
Although there is substantial evidence regarding the utility of TAVR in patients
with classic high-gradient symptomatic AS, the management of patients with
discordant AS and gradients that are lower than expected remains uncertain. As
low-gradient AS is quite prevalent, it warrants our attention. The TAVR approach in
*Corresponding author: these patients requires risk stratification and additional imaging modalities, such
Tom Kai Ming Wang
(wangt2@ccf.org) as stress echocardiography, to more accurately evaluate the severity of AS. TAVR
complications include stroke, kidney injury, conduction abnormalities, device-
Citation: Majid M, Rosenzveig A, related thrombosis, endocarditis, and mechanical or vascular complications, which
Haroun E, et al. A contemporary
review of transcatheter aortic affect both patients with low- and high-gradient AS (HGAS). Contemporary research
valve replacement in low-gradient has demonstrated that TAVR is more effective in the low-gradient AS population
aortic stenosis. Brain & Heart. than in the HGAS population and shows better outcomes than conservative
2025;3(1):4017.
doi: 10.36922/bh.4017 management. The management of patients with AS, particularly low-gradient AS,
remains poorly understood.
Received: June 22, 2024
Accepted: October 15, 2024
Keywords: Transcatheter aortic valve replacement; Aortic stenosis; Low-flow low-
Published online: December 10, gradient aortic stenosis; Valvular heart disease
2024
Copyright: © 2024 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution 1. Introduction
License, permitting distribution,
and reproduction in any medium, Transcatheter aortic valve replacement (TAVR) has emerged as an invaluable alternative
provided the original work is to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) across
properly cited. the spectrum of surgical risk. The need for valve replacement depends on AS severity. AS
1
Publisher’s Note: AccScience severity is assessed based on echocardiographic parameters, including peak and mean
Publishing remains neutral with velocities and gradients and aortic valve area (AVA). Although classical high-gradient AS
2
regard to jurisdictional claims in 2
published maps and institutional (HGAS) is diagnosed based on a mean gradient of ≥40 mmHg, AVA of ≤1.0 cm , and peak
2
affiliations. velocity of ≥4 m /s, these measurements are not infrequently discordant. Discordant AS

Volume 3 Issue 1 (2025) 1 doi: 10.36922/bh.4017