The prognostic value of low-flow in severe aortic stenosis patients undergoing TAVI - should we follow the flow?

Abstract Funding Acknowledgements Type of funding sources: None. Background Low-flow conditions are associated with higher mortality after transcatheter aortic valve implantation (TAVI) for severe stenosis (SAS). Two parameters have been described to determine low-flow status – although the most currently used is stroke volume index, transaortic flow rate (FR divided by left ventricle ejection time) was recently suggested as being superior, it more closely reflects valvular resistance. Purpose Determine prognostic impact in survival patients undergoing TAVI SAS, using low-FR and low-SVi definitions. Methods A database comprising all treated between 2011 2019 a single-centre retrospectively analyzed, cases echocardiograms performed before intervention our centre were included. defined according basal FR<200mL/s or SVi<35mL/m2, compared normal counterparts. The tested Kaplan-Meier curves, log-rank test Cox proportional hazard model adjusted EuroSCORE II, FR SVi both categorical continuous variables. subsequent analysis preserved reduced fraction (EF, <52%). Primary endpoint time all-cause last follow-up over five years TAVI. Results Of 657 performed, 490 (74.6%) included present analysis, median 56 months. these, 59.6% presented low-FR, 43.3% had low-SVI. patients, each definition, estimated surgical risk (EuroSCORE STS), advanced NYHA class, worse creatinine clearance, frequently coronary disease. Additionally, older female. Atrial fibrillation common cases. Echocardiographic studies revealed lower functional area cases, gradients, EF Low-FR [Hazard Ratio (HR) 1.43 (1.06–1.92), p = 0.019)], even adjusting II [HR 1.39 (1.03–1.90), 0.034], which not observed (p 0.06 0.2 uni- multivariable respectively). When analyzing variables, SVi, but FR, improved 0.98 (0.97–1.00), 0.018; HR 0.99 0.044 stratifying EF, did predict mortality. Conclusions About half SAS condition, heart failure symptoms risk. negatively impacts intervention. also prognostic, at <35ml/s cut-off.