Flow-status and survival in severe aortic stenosis treated with TAVI – is flow rate superior to stroke volume index?

Abstract Background Low-flow status, currently defined as a stroke volume index (SVi) <35 mL/m2, is an important prognostic predictor for mortality after Transcatheter Aortic Valve Implantation (TAVI) severe aortic stenosis (SAS). However, transaortic flow rate (FR) – divided by left ventricle ejection time - has recently been suggested to be superior SVi in defining low-flow states, it reflects more closely valvular resistance, while being independent of body surface area. Low FR most consistently FR<200 mL/s. Purpose Determine the impact and before TAVI survival intervention SAS. Methods A single-centre retrospective database all performed between 2011 2019 was analyzed, cases with pre-intervention echocardiograms available were included. patients identified according basal (<200 mL/s) or (<35 mL/m2), compared normal-flow cases. The primary endpoint all-cause death last follow-up. flow-status (using SVi) assessed using Kaplan-Meier curves log-rank test, well Cox proportional hazard model adjusted EuroSCORE II, either categorical continuous variables. subanalysis further preserved reduced fraction (EF, <52%). p<0.05 considered statistically significant. Results From 657 performed, 490 (74.6%) included, median follow-up 43 months. those, 59.6% FR, 43.3% SVi. patients, each parameter, higher surgical risk (EuroSCORE II STS scores), had advanced NYHA classes, worse estimated creatinine clearance, suffered frequently from coronary artery disease. Low-FR also older, predominantly female. Atrial fibrillation prevalent among low Functional valve area lower both assessments, but low-SVi associated gradients, EF TAVI. Regarding mortality, [p=0.02, ratio (HR) 1.43 (1.05–1.94)], not low-FR (p=0.4). low-SVi, when EuroScore no longer (p=0.08). When considering variables, (but FR) better (HR 0.98, p=0.047) multivariable analysis II. stratifying EF, did predict mortality. Conclusions states are common SAS population treated TAVI, symptoms procedural risk. Low-SVi, low-FR, negatively impacts intervention, representing marker prognosis Funding Acknowledgement Type funding sources: None.