Transcatheter aortic valve implantation (TAVI) has emerged as an effective therapy
for patients with severe aortic stenosis (AS). However, data on TAVI outcomes in patients
with low gradient (LG) AS are limited. We performed a meta-analysis of studies comparing
TAVI outcomes between patients with classic high gradient (HG) and LG AS through November
2018. The 30-day mortality, mid-term all-cause, and cardiovascular mortality at maximum
follow-up were compared between patients with HG and LG AS (Pairwise meta-analysis),
and between the three distinct groups of AS including HG, paradoxical low-flow low-gradient
and low gradient with reduced ejection fraction (rEF-LG) (Network meta-analysis).
Nineteen studies (n = 27,204 patients) met the inclusion criteria. The HG group had
less 30-day, mid-term all-cause and cardiovascular mortality compared with the low-gradient
AS group overall, (6% vs 7.5%, OR 0.76, 95% CI 0.66 to 0.87, I2 = 18%), (21% vs 29%, OR 0.59, 95% CI 0.52 to 0.67, I2 = 62%), and (12.6% vs 18.7%, OR 0.61, 95% CI 0.49 to 0.76, I2 = 62%), respectively, p <0.0001. These outcomes were confirmed in a trial sequential
analysis in which the cumulative Z-curve crossed the conventional test boundary as
well as the trial sequential monitoring boundary for all outcomes. The network meta-analysis
revealed that patients with rEF-LG had similar outcomes to those with pLFLG, and both
had worse outcomes than patients with classic HG AS. In conclusion patients with classic
HG have better 30-day mortality, mid-term all-cause and cardiovascular mortality compared
with LG patients following TAVI. Among patients with LG severe AS, TAVI outcomes were
similar in patients with rEF-LG and pLFLG.
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Article Info
Publication History
Published online: May 09, 2019
Received in revised form:
April 17,
2019
Received:
January 25,
2019
Identification
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© 2019 Elsevier Inc. All rights reserved.
