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Invited Commentary
August 2016

Low-Flow Aortic Stenosis After Transcutaneous Aortic Valve Replacement: It’s All About the Flow

Author Affiliations
  • 1Bluhm Cardiovascular Institute, Department of Cardiology, Northwestern University, Chicago, Illinois
JAMA Cardiol. 2016;1(5):592-593. doi:10.1001/jamacardio.2016.1206

Along the spectrum of aortic stenosis (AS) lie patients with severely reduced valve area (<1.0 cm2 or <0.6 cm2/m2 when indexed to body surface area) but low cardiac stroke volume index (SVI; generally considered to be <35 mL/m2). Such patients have a worse natural history than patients with normal SVI, and while their survival is improved by surgical or transcutaneous aortic valve replacement (SAVR or TAVR, respectively), it remains worse than those without low flow.1 To better understand the determinants of outcomes in these patients, in this issue of JAMA Cardiology Anjan et al2 have analyzed 984 patients with SVI less than 35 mL/m2 from the Placement of Aortic Transcatheter Valves (PARTNER) trial who underwent TAVR, assessing which baseline and immediate postprocedural characteristics are predictive of 1-year mortality.