German researchers report success with transcatheter aortic valve implantation (TAVI) in patients with low-flow, low-gradient aortic stenosis—a special form of aortic stenosis that is difficult to treat. Results published in the April issue of Catheterization and Cardiovascular Interventions, the peer-reviewed journal of the Society for Cardiovascular Angiography and Interventions (SCAI), show that while all-cause mortality was high within the first six months, TAVI significantly improved heart function and exercise capacity in surviving patients.
While low-flow, low-gradient aortic stenosis occurs in only 5% of patients with aortic stenosis, treatment of these patients remains challenging. Previous research shows a more discouraging prognosis for patients receiving conservative therapy and higher mortality following surgical aortic valve replacement. Over the past few years, TAVI has been used as an alternative treatment for patients with severe aortic stenosis or in those deemed a high surgical risk.
A team led by Dr. Michael Gotzmann, with the University-Hospital Bergmannsheil in Bochum, Germany performed TAVI in 167 consecutive patients with severe aortic stenosis and high operative risk between June 2008 and December 2010. Of those participating, 15 patients had low-flow, low-gradient aortic stenosis and the remaining 152 patients were part of the control group. Interventionists used the Medtronic CoreValve prosthesis 18-F generation for this study.
Within the first 6 months following TAVI, 25 patients died—13% without and 33% with low-flow, low-gradient aortic stenosis. These patients had a higher all-cause mortality following TAVI compared to patients without this severe form of disease. However, the surviving 10 patients with low-flow, low-gradient aortic stenosis reached the 6-month mark, and after nearly a year post-procedure no additional death, myocardial infarction, or stroke occurred.
Furthermore, the surviving patients displayed a significant improvement in heart function and exercise capacity. "While there is a high mortality rate in this difficult-to-treat patient group, there is symptomatic benefit for patients undergoing TAVI therapy," said Dr. Gotzmann. The authors suggest the high mortality rate could be due to pre-existing conditions that place patients are greater risk post-procedure. "Further multi-center studies in larger patient populations are needed to understand the potential benefit of TAVI in patients with low-flow, low-gradient aortic stenosis," concludes Dr. Gotzmann.
This study is published in Catheterization and Cardiovascular Interventions. Media wishing to receive a PDF of the article may contact healthnews@wiley.com.
Full citation:"Clinical Outcome of Transcatheter Aortic Valve Implantation in Patients with Low-Flow, Low Gradient Aortic Stenosis." Michael Gotzmann, Michael Lindstaedt, Waldemar Bojara, Aydan Ewers and Andreas Mügge. Catheterization and Cardiovascular Interventions; Published Online: August 5, 2011 (DOI: 10.1002/ccd.23240) Print Issue: April 2012. http://onlinelibrary.wiley.com/doi/10.1002/ccd.23240/abstract
Author Contact: To arrange an interview with Dr. Gotzmann, please contact Robin Jopp with the University-Hospital Bergmannsheil at robin.jopp@bergmannsheil.de or at +49 234 302-6125.
Catheterization and Cardiovascular Interventions is the official journal of The Society for Cardiovascular Angiography and Interventions. This international journal covers the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability. For more information, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1522-726X.
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