Risk of mortality following transcatheter aortic valve replacement for low-flow low-gradient aortic stenosis



Low-flow low-gradient (LF-LG) aortic stenosis (AS) is associated with high mortality, even after transcatheter aortic valve replacement (TAVR). Further knowledge of risk indicators is needed and a clinical risk score would be desirable for optimizing patient selection and therapeutic strategy.


The study cohort comprised of 219 consecutive LF-LG AS patients undergoing TAVR from 2008 to 2018 in two high-volume German centers. Predictive factors for one-year all-cause mortality were defined according to a Cox proportional hazard model.


At one-year follow-up after TAVR, 28% of patients had died. A multivariate model revealed six independent predictors of one-year mortality: history of myocardial infarction (HR 2.05, 95%CI 1.13–3.72), eGFR < 30 ml/min/1.73m2 (HR 2.75, 95%CI 1.48–5.11), tricuspid regurgitation moderate or more (HR 2.06, 95%CI 1.14–3.72), stroke volume index < 25 mL/m2 (HR 2.03, 95%CI 1.14–3.62), self-expandable device (HR 2.72, 95%CI 1.17–6.27), and non-transfemoral approach (HR 3.42, 95%CI 1.28–9.14). The Rhineland Risk Score (RRS) consisting of these variables (c statistic 0.75, 95%CI 0.68–0.82, p < 0.001) was superior to the EuroSCORE II (c statistic 0.63) and STS-PROM score (c statistic 0.69) at predicting one-year mortality. Patients with a RRS ≥ 8 had a prohibitive risk of one-year mortality of 67.6% (95%CI 52.0–82.4%).


In patients with LF-LG AS, history of myocardial infarction, renal dysfunction, tricuspid regurgitation, a low stroke volume index, self-expandable device, and non-femoral approach were associated with increased 1-year mortality after TAVR. The RRS might serve as a helpful tool for risk prediction and patient selection for TAVR in patients with LF-LG AS.

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We thank Dr. Meghan Campbell (scientific coordinator for the Heart Center Bonn, Bonn, Germany) for proofreading the manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Correspondence to Vedat Tiyerili.

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Wilde, N., Sugiura, A., Sedaghat, A. et al. Risk of mortality following transcatheter aortic valve replacement for low-flow low-gradient aortic stenosis. Clin Res Cardiol (2020). https://doi.org/10.1007/s00392-020-01752-4

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  • Aortic stenosis
  • Low-flow low-gradient
  • Ejection fraction
  • Transcatheter aortic valve implantation
  • Risk factor
  • Mortality