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REVIEW ARTICLE

A contemporary review of transcatheter aortic valve replacement in low-gradient aortic stenosis

Muhammad Majid1,2 ,  Akiva Rosenzveig1 ,  Elio Haroun1 ,  Aro Daniela Arockiam1 ,  Ankit Agrawal1 ,  Sharmeen Sorathia1 ,  Rochell Issa1 ,  Tiffany Dong1 ,  Nithila Sivakumar1 ,  Tom Kai Ming Wang1*
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1 Department of Cardiovascular Medicine, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
2 Department of Internal Medicine, Advent Health Sebring, Sebring, Florida, United States of America
Brain & Heart, 4017 https://doi.org/10.36922/bh.4017
Submitted: 22 June 2024 | Accepted: 15 October 2024 | Published: 10 December 2024
(This article belongs to the Special Issue Structural Heart Disease: Recent Updates)
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Transcatheter aortic valve replacement (TAVR) has been approved for patients with severe symptomatic aortic stenosis (AS) across the spectrum of surgical risk. Although there is substantial evidence regarding the utility of TAVR in patients with classic high-gradient symptomatic AS, the management of patients with discordant AS and gradients that are lower than expected remains uncertain. As low-gradient AS is quite prevalent, it warrants our attention. The TAVR approach in these patients requires risk stratification and additional imaging modalities, such as stress echocardiography, to more accurately evaluate the severity of AS. TAVR complications include stroke, kidney injury, conduction abnormalities, device-related thrombosis, endocarditis, and mechanical or vascular complications, which affect both patients with low- and high-gradient AS (HGAS). Contemporary research has demonstrated that TAVR is more effective in the low-gradient AS population than in the HGAS population and shows better outcomes than conservative management. The management of patients with AS, particularly low-gradient AS, remains poorly understood.

Keywords
Transcatheter aortic valve replacement
Aortic stenosis
Low-flow low-gradient aortic stenosis
Valvular heart disease
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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