# Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literature

## TL;DR

This study finds that patients with very severe aortic stenosis may have better outcomes after a specific heart valve procedure compared to those with severe aortic stenosis.

## Contribution

The study provides new evidence that very severe aortic stenosis patients benefit as much or more from TAVI compared to severe cases.

## Key findings

- Procedural outcomes were similar between very severe and severe aortic stenosis groups after TAVI.
- Very severe aortic stenosis patients showed a favorable trend in lower mortality after TAVI.
- The mortality benefit was significant in female and NYHA class III subgroups.

## Abstract

Very severe aortic stenosis (VSAS) is a critical condition with unfavourable clinical outcomes if left untreated or treated by surgical valve replacement. In contrast, after transcatheter valve implantation (TAVI) outcomes seem to be similar or – paradoxically – even better compared to severe aortic stenosis (SAS), as indicated by previous studies.

Data of patients from a single centre who underwent TAVI were retrospectively analysed. Patients with concordant AS (n = 475) were divided into SAS (n = 379) and VSAS (n = 96) groups. These groups are compared in terms of procedural (safety) and long-term (efficacy) outcomes, using propensity score matching. In addition, a review of relevant literature is provided.

After propensity score matching, 96 patients remained in each group. Procedural outcomes did not differ significantly between VSAS and SAS groups. Cox proportional hazards regression analysis showed a favourable trend toward lower overall mortality within a mean follow-up of 42 months after TAVI in the VSAS group (hazard ratio, HR, 0.668; 95 % confidence interval, CI, 0.430–1.038). This difference did not reach statistical significance (p = 0.073), however, it was significant in the subgroups of females (p = 0.045) and patients with NYHA class III (p = 0.043).

Our analysis confirms – in line with previous studies – that patients with VSAS represent a substantial subgroup and have at least as favourable or – paradoxically −even better clinical results after TAVI compared to patients with SAS. Therefore, TAVI should not be withheld from these patients.