{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:03:04Z","timestamp":1785250984720,"version":"3.55.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">There are uncertainties regarding long\u2010term outcomes of low\u2010flow, low\u2010gradient (LFLG) severe aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR). This study investigates long\u2010term outcomes of TAVR for high\u2010gradient (HG), classical LFLG, and paradoxical LFLG AS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We systematically searched PubMed, Embase, Scopus, and Cochrane Library databases until January 2025 for studies comparing HG, classical LFLG, and paradoxical LFLG AS outcomes following TAVR. The primary outcome was all\u2010cause mortality, analyzed using reconstructed individual patient data meta\u2010analysis. Secondary outcomes included cardiovascular mortality, heart failure hospitalization, acute kidney injury, bleeding events, stroke, myocardial infarction, permanent pacemaker implantation, and echocardiographic outcomes, analyzed using multivariate meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">We included 19 observational studies comprising 20\u2009493 patients who underwent TAVR for severe AS. Time\u2010to\u2010event meta\u2010analysis indicated a higher risk of 5\u2010year all\u2010cause mortality in patients with classical and paradoxical LFLG AS compared with HG AS (hazard ratio [HR], 1.92 [95% CI, 1.62\u20132.27] and HR, 1.20 [95% CI, 1.07\u20131.34], respectively). Multivariate meta\u2010analysis indicated an increased risk of cardiovascular mortality in patients with LFLG versus HG AS (classical LFLG HR, 1.94 [95% CI, 1.74\u20132.16]; paradoxical LFLG HR, 1.40 [95% CI, 1.25\u20131.57]). Classical and paradoxical LFLG AS were also associated with a higher risk of heart failure hospitalization (HR, 4.12 [95% CI, 2.16\u20137.83]; HR, 1.80 [95% CI, 1.14\u20132.85], respectively) compared with HG AS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Classical and paradoxical LFLG AS were associated with higher all\u2010cause and cardiovascular mortality following TAVR compared with HG AS. Future studies are needed to determine strategies to improve outcomes following TAVR in patients with LFLG AS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044431","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T09:16:42Z","timestamp":1777281402000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Outcomes of Transcatheter Aortic Valve Replacement in Low\u2010Flow Low\u2010Gradient Aortic Stenosis: A Reconstructed Time\u2010to\u2010Event and Multivariate Meta\u2010Analysis"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5092-4127","authenticated-orcid":false,"given":"Arman","family":"Soltani Moghadam","sequence":"first","affiliation":[{"name":"Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Kazemian","sequence":"additional","affiliation":[{"name":"Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saman","family":"Soltani Moghadam","sequence":"additional","affiliation":[{"name":"Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parisa","family":"Nasiri","sequence":"additional","affiliation":[{"name":"Shahid Beheshti University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0762-822X","authenticated-orcid":false,"given":"Azad","family":"Mojahedi","sequence":"additional","affiliation":[{"name":"Stony Brook University Hospital","place":["Stony Brook, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7466-0807","authenticated-orcid":false,"given":"Babak","family":"Geraiely","sequence":"additional","affiliation":[{"name":"Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7939-9306","authenticated-orcid":false,"given":"Farnoosh","family":"Larti","sequence":"additional","affiliation":[{"name":"Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9035-343X","authenticated-orcid":false,"given":"Azeem","family":"Latib","sequence":"additional","affiliation":[{"name":"Montefiore Medical Center","place":["The Bronx, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-4384","authenticated-orcid":false,"given":"Andrea","family":"Scotti","sequence":"additional","affiliation":[{"name":"Montefiore Medical Center","place":["The Bronx, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2487-8366","authenticated-orcid":false,"given":"Toshiki","family":"Kuno","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, USA"]},{"name":"Harvard Medical School","place":["Boston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7107-3667","authenticated-orcid":false,"given":"Dhaval","family":"Kolte","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/circinterventions.122.012538"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.124.036179"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.01.012"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000932"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.06.051"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.668681"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2012.10.013"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.112.001290"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2025.04.034"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2023.01.020"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf194"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.12.028"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-015-0889-1"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1445-2197.2003.02748.x"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-021-01308-8"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajps.12176"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.4244\/eij-d-24-00442"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jscai.2023.101266"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-024-02482-7"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.123.029489"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.repc.2022.03.002"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-022-02011-4"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/circinterventions.120.010042"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1080\/24748706.2020.1764155"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.4244\/eij-d-19-00399"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.5114\/aic.2019.83770"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2018-000988"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.01.233"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.117.007977"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.04.044"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.4244\/eij-d-16-00801"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26253"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.4244\/eijv10i7a145"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.044"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht408"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2021.04.038"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jscai.2023.101255"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.12.054"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/802840"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.107.757427"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.121.021126"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11936-018-0642-y"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.4244\/eijv10sua9"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.123.029717"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.044431","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:46:34Z","timestamp":1785249994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.044431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":44,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,5,5]]}},"alternative-id":["10.1161\/JAHA.125.044431"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.044431","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"assertion":[{"value":"2025-06-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e044431"}}