# Different Types of Aortic Valve Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement

## TL;DR

This study finds that nearly 20% of patients undergoing TAVR have non-classical aortic stenosis types, with similar survival rates except for those with low-gradient AS and impaired heart function.

## Contribution

The study provides new insights into clinical outcomes of different aortic stenosis subtypes in TAVR patients using a large global database.

## Key findings

- Nearly 20% of TAVR patients have discordant aortic stenosis types.
- Low-gradient AS with impaired LVEF had higher 1-year mortality compared to concordant high-gradient AS.
- Concordant high-gradient AS patients had higher major bleeding rates.

## Abstract

Transcatheter aortic valve replacement (TAVR) is an effective treatment in patients with “classical” concordant high-gradient aortic stenosis (AS). However, data on outcomes in patients with discordant AS are scarce. Our study aims to investigate the clinical outcomes of patients undergoing TAVR with different types of AS.

The Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation 2 (CENTER2) study is a patient-level database including 25,771 patients who underwent TAVR, of whom 15,233 were included in this analysis. Four AS subgroups were identified, and patients were classified as discordant AS (low-gradient AS with preserved or impaired left ventricular ejection fraction [LVEF] or discordant high-gradient AS) or concordant high-gradient AS.

A total of 15,233 patients underwent TAVR. The mean age was 81.5 ± 6.8 years, 56% were women, and Society of Thoracic Surgeons Predicted Risk of Mortality was 4.8% (interquartile range [IQR] 3.0-8.0%). Of these, 2731 (17.9%) patients had low-gradient AS with preserved or impaired LVEF, 138 (0.9%) discordant high-gradient AS, and 12,364 (81.2%) concordant high-gradient AS. There was no difference in 1-year mortality between discordant AS and concordant high-gradient AS (13.1 vs. 11.9%, adjusted hazard ratio 1.19, p = 0.08). One-year mortality rates was higher in low-gradient AS with impaired LVEF compared to concordant high-gradient AS (15.9 vs. 11.9%, adjusted hazard ratio 1.43, p = 0.01). Patients with concordant high-gradient AS had higher major bleeding rates (6.7%) compared to both low-gradient AS with impaired LVEF (4.0%) and preserved LVEF (5.4%) (p < 0.001 and p = 0.04).

Nearly 20% of patients undergoing TAVR had discordant AS. One-year mortality was higher in low-gradient AS with impaired LVEF, whereas outcomes were similar among low-gradient with preserved LVEF, discordant high-gradient, and concordant high-gradient AS.

•The global Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation 2 study reveals that nearly 20% of patients undergoing transcatheter aortic valve replacement do not exhibit the classical concordant high-gradient aortic stenosis (AS) profile.•Patients with low-gradient AS with impaired left ventricular ejection fraction experienced the highest 1-year mortality rate.•Low-gradient AS with preserved left ventricular ejection fraction, discordant high-gradient AS, and concordant high-gradient AS had similar 1-year survival.•Bleeding after transcatheter aortic valve replacement was most frequent in patients with concordant high-gradient AS.

The global Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation 2 study reveals that nearly 20% of patients undergoing transcatheter aortic valve replacement do not exhibit the classical concordant high-gradient aortic stenosis (AS) profile.

Patients with low-gradient AS with impaired left ventricular ejection fraction experienced the highest 1-year mortality rate.

Low-gradient AS with preserved left ventricular ejection fraction, discordant high-gradient AS, and concordant high-gradient AS had similar 1-year survival.

Bleeding after transcatheter aortic valve replacement was most frequent in patients with concordant high-gradient AS.