{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T02:46:54Z","timestamp":1773024414709,"version":"3.50.1"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["PE-2016-02364619"],"award-info":[{"award-number":["PE-2016-02364619"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Patients with non-paradoxical low-flow\u2013low-gradient (LFLG) aortic stenosis (AS) are at increased surgical risk, and thus, they may particularly benefit from transcatheter aortic valve replacement (TAVR). However, data on this issue are still limited and based on the results with older-generation transcatheter heart valves (THVs). The aim of this study was to investigate early and mid-term outcome of TAVR with newer-generation THVs in the setting of LFLG AS. Data for the present analysis were gathered from the OBSERVANT II dataset, a national Italian observational, prospective, multicenter cohort study that enrolled 2,989 consecutive AS patients who underwent TAVR at 30 Italian centers between December 2016 and September 2018, using newer-generation THVs. Overall, 420 patients with LVEF \u226450% and mean aortic gradient &amp;lt;40 mmHg were included in this analysis. The primary outcomes were 1-year all-cause mortality and a combined endpoint including all-cause mortality and hospital readmission due to congestive heart failure (CHF) at 1 year. A risk-adjusted analysis was performed to compare the outcome of LFLG AS patients treated with TAVR (<jats:italic>n<\/jats:italic> = 389) with those who underwent surgical aortic valve replacement (SAVR, <jats:italic>n<\/jats:italic> = 401) from the OBSERVANT I study. Patients with LFLG AS undergoing TAVR were old (mean age, 80.8 \u00b1 6.7 years) and with increased operative risk (mean EuroSCORE II, 11.5 \u00b1 10.2%). VARC-3 device success was 83.3% with 7.6% of moderate\/severe paravalvular leak. Thirty-day mortality was 3.1%. One-year all-cause mortality was 17.4%, and the composite endpoint was 34.8%. Chronic obstructive pulmonary disease (HR 1.78) and EuroSCORE II (HR 1.02) were independent predictors of 1-year mortality, while diabetes (HR 1.53) and class NYHA IV (HR 2.38) were independent predictors of 1-year mortality or CHF. Compared with LFLG AS treated with SAVR, TAVR patients had a higher rate of major vascular complications and permanent pacemaker, while SAVR patients underwent more frequently to blood transfusion, cardiogenic shock, AKI, and MI. However, 30-day and 1-year outcomes were similar between groups. Patients with non-paradoxical LFLG AS treated by TAVR were older and with higher surgical risk compared with SAVR patients. Notwithstanding, TAVR was safe and effective with a similar outcome to SAVR at both early and mid-term.<\/jats:p>","DOI":"10.3389\/fcvm.2022.991729","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T07:22:18Z","timestamp":1665040938000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Early and mid-term outcome of patients with low-flow\u2013low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves"],"prefix":"10.3389","volume":"9","author":[{"given":"Chiara","family":"Fraccaro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Tarantini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Rosato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Baglio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fausto","family":"Biancari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Barbanti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corrado","family":"Tamburino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Bedogni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Ranucci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gian Paolo","family":"Ussia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fulvia","family":"Seccareccia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"D'Errigo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2021","journal-title":"Eur Heart J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2645","DOI":"10.1093\/eurheartj\/ehw096","article-title":"Low-gradient aortic stenosis","volume":"37","author":"Clavel","year":"2016","journal-title":"Eur Heart J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1016\/s1010-7940(03)00575-x","article-title":"Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction: determinants of cardiac mortality and ventricular function recovery","volume":"24","author":"Tarantini","year":"2003","journal-title":"Eur J Cardiothorac Surg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1161\/01.cir.101.16.1940","article-title":"Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction:result of aortic valve replacement in 52 patients","volume":"101","author":"Connolly","year":"2000","journal-title":"Circulation."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1016\/S0735-1097(02)01759-X","article-title":"Survival after aortic valve replacement forsevere aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction","volume":"39","author":"Pereira","year":"2002","journal-title":"J Am Coll Cardiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1136\/hrt.2004.044099","article-title":"Valve replacement in patients with critical aortic stenosis and depressed left ventricular function: predictors of operative risk, left ventricular function recovery, and long term outcome","volume":"91","author":"Vaquette","year":"2005","journal-title":"Heart."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1016\/j.jacc.2007.10.067","article-title":"Aortic valve replacement for low-flow\/low-gradient aortic stenosis","volume":"51","author":"Levy","year":"2008","journal-title":"J Am Coll Cardiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1865","DOI":"10.1016\/j.jacc.2009.02.026","article-title":"Outcome after aortic valve replacement for low-flow\/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography","volume":"53","author":"Tribouilloy","year":"2009","journal-title":"J Am Coll Cardiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1016\/j.athoracsur.2011.02.057","article-title":"Valve replacement for severe aortic stenosis with low transvalvular gradient and left ventricular ejection fraction exceeding 0","volume":"91","author":"Tarantini","year":"2011","journal-title":"Ann Thorac Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1928","DOI":"10.1161\/CIRCULATIONAHA.109.929893","article-title":"Comparison between transcatheter and surgical prosthetic valve implantation in patients with severe aortic stenosis and reduced left ventricular ejection fraction","volume":"122","author":"Clavel","year":"2010","journal-title":"Circulation."},{"key":"B11","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1007\/s00392-015-0865-9","article-title":"Impact of left ventricular conduction defect with or without need for permanent right ventricular pacing on functional and clinical recovery after TAVR","volume":"104","author":"Weber","year":"2015","journal-title":"Clin Res Cardiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s10741-021-10090-0","article-title":"How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice","volume":"27","author":"Contorni","year":"2022","journal-title":"Heart Fail Rev."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2316","DOI":"10.1161\/CIRCULATIONAHA.112.001290","article-title":"Predictors of mortality and outcomes of therapy in low-flow severe aortic stenosis: a Placement of Aortic Transcatheter Valves (PARTNER) trial analysis","volume":"127","author":"Herrmann","year":"2013","journal-title":"Circulation."},{"key":"B14","doi-asserted-by":"publisher","first-page":"850","DOI":"10.4244\/EIJV10I7A145","article-title":"TAVI for low-flow, low-gradient severe aortic stenosis with preserved or reduced ejection fraction: a subgroup analysis from the German Aortic Valve Registry (GARY)","volume":"10","author":"Lauten","year":"2014","journal-title":"EuroIntervention."},{"key":"B15","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1002\/ccd.25366","article-title":"Clinical presentation and outcomes after transcatheter aortic valve implantation in patients with low flow\/low gradient severe aortic stenosis","volume":"84","author":"Elhmidi","year":"2014","journal-title":"Catheter Cardiovasc Interv."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1016\/j.jacc.2018.01.054","article-title":"Transcatheter aortic valve replacement in patients with low-flow, low-gradient aortic stenosis: the TOPAS-TAVI registry","volume":"71","author":"Ribeiro","year":"2018","journal-title":"J Am Coll Cardiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e007825","DOI":"10.1161\/CIRCINTERVENTIONS.119.007825","article-title":"Five-year outcomes of transfemoral transcatheter aortic valve replacement or surgical aortic valve replacement in a real world population","volume":"12","author":"Barbanti","year":"2019","journal-title":"Circ Cardiovasc Interv."},{"key":"B18","doi-asserted-by":"publisher","first-page":"14S","DOI":"10.1714\/2718.27731","article-title":"[OBSERVANT II: OBservational Study of Effectiveness of transcatheter aortic valve implantation with new geneRation deVices for severe Aortic steNosis Treatment. Study protocol]","volume":"18","author":"Seccareccia","year":"2017","journal-title":"G Ital Cardiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"3703","DOI":"10.3390\/jcm10163703","article-title":"One-year outcomes after surgical versus transcatheter aortic valve replacement with newer generation devices","volume":"10","author":"Rosato","year":"2021","journal-title":"J Clin Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.3390\/jcm11051164","article-title":"One-year outcomes and trends over two eras of transcatheter aortic valve implantation in real-world practice","volume":"11","author":"Costa","year":"2022","journal-title":"J Clin Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1016\/j.jacc.2015.06.013","article-title":"1-Year outcomes after transfemoral transcatheter or surgical aortic valve replacement: results from the Italian OBSERVANT study","volume":"66","author":"Tamburino","year":"2015","journal-title":"J Am Coll Cardiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/S0140-6736(98)04402-X","article-title":"A brief clinical instrument to classify frailty in elderly people","volume":"353","author":"Rockwood","year":"1999","journal-title":"Lancet."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1093\/eurheartj\/ehaa799","article-title":"Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research","volume":"42","author":"G\u00e9n\u00e9reux","year":"2021","journal-title":"Eur Heart J."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2682","DOI":"10.1161\/CIRCULATIONAHA.113.007477","article-title":"Predictors of poor outcomes after transcatheter aortic valve replacement: results from the PARTNER (Placement of Aortic Transcatheter Valve) trial","volume":"129","author":"Arnold","year":"2014","journal-title":"Circulation."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","article-title":"Transcatheter or surgical aortic-valve replacement in intermediate-risk patients","volume":"374","author":"Leon","year":"2016","journal-title":"N Engl J Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1056\/NEJMoa1700456","article-title":"Surgical or transcatheter aortic-valve replacement in intermediate-risk patients","volume":"376","author":"Reardon","year":"2017","journal-title":"N Engl J Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1016\/j.jcin.2014.01.167","article-title":"Futility, benefit, and transcatheter aortic valve replacement","volume":"7","author":"Lindman","year":"2014","journal-title":"JACC Cardiovasc Interv."},{"key":"B28","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1016\/j.amjcard.2017.09.007","article-title":"Transcatheter aortic valve implantation futility risk model development and validation among treated patients with aortic stenosis","volume":"120","author":"Zusman","year":"2017","journal-title":"Am J Cardiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"4911","DOI":"10.3390\/jcm10214911","article-title":"Identifying patients without a survival benefit following transfemoral and transapical transcatheter aortic valve replacement","volume":"10","author":"Geisler","year":"2021","journal-title":"J Clin Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1161\/CIRCINTERVENTIONS.111.964213","article-title":"Transcatheter aortic valve implantation in patients with severe left ventricular dysfunction: immediate and mid-term results, a multicenter study","volume":"5","author":"Fraccaro","year":"2012","journal-title":"Circ Cardiovasc Interv."},{"key":"B31","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.jcin.2019.08.041","article-title":"Transcatheter Self-expandable valve implantation for aortic stenosis in small aortic annuli: the TAVI-SMALL registry","volume":"13","author":"Regazzoli","year":"2020","journal-title":"JACC Cardiovasc Interv."},{"key":"B32","doi-asserted-by":"publisher","first-page":"E875","DOI":"10.1002\/ccd.29259","article-title":"Transcatheter aortic valve replacement with Evolut R versus Sapien 3 in Japanese patients with a small aortic annulus: the OCEAN-TAVI registry","volume":"97","author":"Hase","year":"2021","journal-title":"Catheter Cardiovasc Interv."},{"key":"B33","doi-asserted-by":"publisher","first-page":"761917","DOI":"10.3389\/fcvm.2022.761917","article-title":"Patient prosthesis mismatch after SAVR and TAVR","volume":"9","author":"Bleiziffer","year":"2022","journal-title":"Front Cardiovasc Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.jtcvs.2005.10.028","article-title":"Prosthesis-patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: effect on survival, freedom from heart failure, and left ventricular mass regression","volume":"131","author":"Ruel","year":"2006","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B35","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.jacc.2008.09.022","article-title":"Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesity, and left ventricular dysfunction","volume":"53","author":"Mohty","year":"2009","journal-title":"J Am Coll Cardiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.ijcard.2017.02.005","article-title":"Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?","volume":"233","author":"Colli","year":"2017","journal-title":"Int J Cardiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1016\/j.jacc.2013.01.047","article-title":"Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature","volume":"61","author":"Athappan","year":"2013","journal-title":"J Am Coll Cardiol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1016\/j.jcin.2021.04.038","article-title":"Impact of surgical and transcatheter aortic valve replacement in low-gradient aortic stenosis: a meta-analysis","volume":"14","author":"Ueyama","year":"2021","journal-title":"JACC Cardiovasc Interv."},{"key":"B39","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1002\/ccd.27914","article-title":"Role of contractile reserve as a predictor of mortality in low-flow, low-gradient severe aortic stenosis following transcatheter aortic valve replacement","volume":"93","author":"Buchanan","year":"2019","journal-title":"Catheter Cardiovasc Interv."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.991729\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T07:22:23Z","timestamp":1665040943000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.991729\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,6]]},"references-count":39,"alternative-id":["10.3389\/fcvm.2022.991729"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.991729","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,6]]},"article-number":"991729"}}