One-third of patients with low flow aortic stenosis do not improve with transcatheter aortic valve replacement

June 15, 2016, University of Pennsylvania School of Medicine

Aortic stenosis (AS), the narrowing of the aortic valve in the heart which causes restricted blood flow, is one of the most common and serious valve disease problems. For patients with one type of AS - low flow - transcatheter aortic valve replacement (TAVR), a minimally invasive procedure which corrects the damaged aortic valve, is often the best option for restoring the heart's normal pumping function. However, approximately one-third of low flow AS patients treated with TAVR continue to suffer persistent low flow AS even after the procedure, ultimately increasing their risk of death. Now, researchers from the Perelman School of Medicine at the University of Pennsylvania have examined this high-risk patient population to determine the cause of this persistent low flow AS and to evaluate their risk of dying during the year following the procedure. Their findings are detailed in a paper published in the Journal of the American Medical Association - Cardiology.

"There has been a lot of interest in these patients with low flow AS, as their surgical mortality is higher than other patients. TAVR is often a good option, but not all of them will be able to normalize flow following the procedure and these persistently low flow patients have a 60 percent higher rate of mortality at one year," said Howard C. Herrmann, MD, FACC, MSCAI, John W. Bryfogle Professor of Cardiovascular Medicine and Surgery, and director of Penn Medicine's Interventional Cardiology Program. "Low flow before TAVR is one of the most important predictors of mortality following TAVR, but it is one of the harder qualities to measure. This presents a challenge to properly treating patients with low flow AS, and can leave some patients at higher risk."

To better understand the potential benefits of TAVR for low flow AS, researchers conducted an analysis of 984 patients with low flow AS from the PARTNER trial and continued access registry from April 2014 through January 2016. A baseline and follow-up echocardiogram, evaluation of post-TAVR hemodynamics - - and one year outcomes were assessed.

Through this analysis, researchers identified the large subgroup of patients who, following TAVR, failed to regain normal flow despite a successful procedure. In the first six months following TAVR, flow improved in roughly 66 percent of the patients evaluated. However, those with severe low flow AS had the highest mortality rate - 26 percent - at one year, as compared to approximately 20 percent for those with moderate low flow and even less for those with normal flow.

"Unfortunately, many centers do not routinely measure flow, but rather focus more on a patient's pressure gradient or valve area when evaluating pre-and post-TAVR," said Herrmann. "While low flow is more challenging to monitor, this measurement can better inform the patient's risk of mortality, and in turn lead to better treatment."

The researchers noted that the identification of remedial, or treatable, causes of persistent low flow following TAVR, such as severe mitral regurgitation and atrial fibrillation, may represent an opportunity to improve the outcomes of these .

Explore further: Study identifies aortic valve gradient as key to TAVR outcomes

Related Stories

Study identifies aortic valve gradient as key to TAVR outcomes

May 16, 2016
Patients with a combination of left ventricular dysfunction and low aortic valve gradient, or reduced force of blood flow through the aortic valve, have higher mortality rates and a greater risk of recurrent heart failure ...

Researchers find similar outcomes for patients with severe aortic stenosis who undergo transcatheter aortic valve replac

April 4, 2016
Nearly 1.5 million Americans have aortic stenosis (AS), the narrowing of the aortic valve opening which restricts blood flow to the aorta. Historically, patients have been treated with open-heart surgery, although recent ...

Researchers find transcatheter aortic valve replacement better for patients with severe aortic stenosis

April 4, 2016
Aortic stenosis (AS), the narrowing of the aortic valve opening which restricts blood flow to the aorta, afflicts nearly 1.5 million people in the United States, with approximately 500,000 of them suffering severe aortic ...

Favorable one-year clinical outcomes for catheter-based aortic valve replacement with latest generation of device

October 15, 2015
Penn Medicine has performed more than 1,200 Transcatheter Aortic Valve Replacements (TAVR) on patients with severe aortic stenosis. Today, at the Transcatheter Cardiac Therapeutics conference in San Francisco, Howard C. Herrmann, ...

SAPIEN 3 improves outcomes for major endpoints at one year

April 4, 2016
Intermediate-risk patients who received transcatheter aortic valve replacement, known as TAVR, with the latest-generation valve fared better than patients receiving traditional surgical aortic valve replacement after one ...

Model developed to help predict risk of in-hospital death after TAVR

March 9, 2016
In a study published online by JAMA Cardiology, Fred H. Edwards, M.D., of the University of Florida College of Medicine-Jacksonville, and colleagues developed a statistical model to predict risk of in-hospital death after ...

Recommended for you

Biomechanical mapping method aids development of therapies for damaged heart tissue

January 23, 2018
Researchers have developed a new way to capture the detailed biomechanical properties of heart tissue. The high-resolution optical technique fills an important technology gap necessary to develop and test therapies that might ...

Researchers borrow from AIDS playbook to tackle rheumatic heart disease

January 22, 2018
Billions of US taxpayer dollars have been invested in Africa over the past 15 years to improve care for millions suffering from the HIV/AIDS epidemic; yet health systems on the continent continue to struggle. What if the ...

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.