Background: Both, aortic stenosis (AS) subtype (high-gradient – HGAS; low-gradient – LGAS; paradoxical low-flow low-gradient – PLFLGAS) as well as the extent of extravalvular cardiac damage according to the 2017 staging classification¹ have be shown to be of prognostic impact regarding patients’ survival. Hitherto, data on long-term mortality in the real-world scenario are rare. Therefore, the current study aimed to address this question in a large prospective single-center registry.

Methods and Results: A total of 619 patients (mean age: 79 ± 7 years; 50% female; mean STS score 4.7 ± 3.9%) that underwent transfemoral TAVI and agreed to participate in the local aortic valve registry at the University Hospital Jena (Jenaer Aortenklappenregister, JAKR) between 2016 and 2020 were included in this analysis. The cohort was classified at baseline according to both, AS subtype (HGAS, 73%; LGAS, 16%; PLFLGAS, 11%) as well as staging based on the extent of cardiac damage (stage 0, 4.0%; stage 1, 16%; stage 2, 45%; stage 3, 22%; stage 4, 13%). In the next step, Kaplan-Meier survival analysis was performed for 30 day, 1-year and 2-year mortality. The latter revealed the following mortality rates for AS subtype (each for HGAS, LGAS and PLFLGAS): 2.8%, 5.3%, 1.6% after 30 days (p=n.s.); 12.6%, 29.8%, 20.6% after 1 year (p<0.001 comparing HGAS vs. LGAS) and 19.3%, 40.4%, 34.9% after 2 years (p<0.001 comparing HGAS vs. LGAS and p=0.005 comparing HGAS vs. PLFLGAS) (figure 1). For the different cardiac damage stages, mortality was as follows (each in comparison between stage 0, 1, 2, 3 and 4): 0%, 2.2%, 3.1%, 3.8%, 3.8% after 30 days (p=n.s.); 0%, 9.7%, 15.6%, 18.3%, 26.9% after 1 year (p<0.05 comparing 0 vs. 3 or 4, 1 or 2 vs. 4) and 0%, 18.3%, 22.1%, 30.5%, 35.9% after 2 years (p<0.05 comparing 0 vs. 1, 2, 3 or 4, 2 vs. 3 or 4) (figure 2).

Conclusion: 

Despite minor variations in the distribution of AS subtypes and cardiac damage stages in our real-world collective compared to recent studies, we could prove their prognostic impact with respect to survival after TAVI. Interestingly, not only for LGAS but also for PLFLGAS, we could demonstrate a significantly decreased 2-year survival compared to HGAS. Of note, for patients without any extravalvular cardiac damage (stage 0), the mortality rate remained 0% even after 2 years in our cohort, which is obviously lower  compared to recent studies. 

¹Généreux et al., European Heart Journal (2017) 38, 3351–3358