RT Journal Article
T1 Transcatheter Aortic Valve Replacement in Patients With Low-Flow, Low-Gradient Aortic Stenosis The TOPAS-TAVI Registry
A1 Henrique Barbosa Ribeiro, 
A1 Josep Rodés-Cabau, 
A1 nombela franco, 
A1 De Agustín Loeches, José Alberto
AB BACKGROUND Few data exist on patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoingtranscatheter aortic valve replacement (TAVR). Also, very scarce data exist on the usefulness of dobutamine stressechocardiography (DSE) before TAVR in these patients.OBJECTIVES The authors sought to evaluate clinical outcomes and changes in left ventricular ejection fraction (LVEF)following TAVR in patients with classical LFLG-AS.METHODS This multicenter registry included 287 patients with LFLG-AS undergoing TAVR. DSE was performed beforeTAVR in 234 patients and the presence of contractile reserve was defined as an increase of $20% in stroke volume.Transthoracic echocardiography was repeated at hospital discharge and at 1-year follow-up. Clinical follow-up wasobtained at 1 and 12 months, and yearly thereafter.RESULTS The median Society of Thoracic Surgeons score of the study population was 7.7% (interquartile range 5.3% to12.0%), and the mean LVEF and transvalvular gradient were 30.1   9.7% and 25.4   6.6 mm Hg, respectively. The presenceof contractile reserve was observed in 45% of patients at DSE. Mortality rates were 3.8%, 20.1%, and 32.3% at 30 days,1 year, and 2 years, respectively. On multivariable analysis, chronic obstructive pulmonary disease (p ¼ 0.022) and lowerhemoglobin values (p < 0.001) were associated with all-cause mortality. Lower hemoglobin values (p ¼ 0.004) andmoderate-to-severe aortic regurgitation post-TAVR (p ¼ 0.018) were predictors of the composite of mortality and rehospitalization due to heart failure. LVEF increased by 8.3% (95% confidence interval: 6% to 11%) at 1-year follow-up, and thelack of prior coronary artery bypass graft (p ¼ 0.004), a lower LVEF at baseline (p < 0.001), and a lower stroke volume indexat baseline (p ¼ 0.019) were associated with greater increase in LVEF. The absence of contractile reserve at baseline DSE wasnot associated with any negative effect on clinical outcomes or LVEF changes at follow-up.CONCLUSIONS TAVR was associated with good periprocedural outcomes in patients with LFLG-AS. However, approximately one-third of LFLG-AS TAVR recipients died at 2-year follow-up, with pulmonary disease, anemia, and residualparavalvular leaks associated with poorer outcomes. LVEF improved following TAVR, but DSE failed to predict clinical outcomes or LVEF changes over time. . (Multicenter Prospective Study of Low-Flow Low-Gradient Aortic Stenosis [TOPAS Study];NCT01835028) (J Am Coll Cardiol 2018;71:1297–308)
PB Elsevier
YR 2018
FD 2018-01-15
LK https://hdl.handle.net/20.500.14352/134144
UL https://hdl.handle.net/20.500.14352/134144
LA eng
NO Ribeiro HB, Lerakis S, Gilard M, Cavalcante JL, Makkar R, Herrmann HC, et al. Transcatheter Aortic Valve Replacement in Patients With Low-Flow, Low-Gradient Aortic Stenosis. Journal of the American College of Cardiology 2018;71:1297–308. https://doi.org/10.1016/j.jacc.2018.01.054
DS Docta Complutense
RD 26 abr 2026