The prognostic value of left ventricular dimensions at the time of transcatheter aortic valve replacement: A propensity-matched analysis

itAbstractAims:In the clinical practice a noteworthy proportion of severe symptomatic aorticstenosis patients presents with low‐flow low‐gradients features, these having re-ported a less favorable prognosis even when surgically or transcatheter treated.Methods and Results:We retrospectively analyzed the prospectively collected dataon 1051 consecutive patients undergone balloon‐expandable transcatheter aorticvalve replacement at our Institution from January 2008 to January 2020. We dividedthe population according with a mean aortic gradient (MAG) < or≥40 mmHg and weperformed a propensity‐matched analysis based on the Society of Thoracic SurgeryScore and age, obtaining two homogeneous groups of 314 patients each (Groups Aand B, respectively). We then analyzed the outcomes of the two groups by im-plementing adjusted Cox models adjusted for significant clinical differences betweenthe two groups, such as sex, ejection fraction, comorbidities and other variables notincluded in the propensity‐matched analysis. The only variable associated with bothcardiovascular and all‐cause events was an ejection fraction≤35%. Finally, a sensi-tivity analysis found that an ejection fraction≤35% was associated with an increasecardiovascular and all‐cause mortality only in patients with an indexed end‐diastolicvolume >97 ml/m2(p= .0438 and .3363, respectively).Conclusions:In our series a MAG <40 mmHg was not found to be per se an in-dependent risk factor for cardiac and all‐cause mortality after transcatheter aorticvalve replacement. The ejection fraction was found to be an independent risk factoronly in the context of enlarged left ventricular dimensions.