Impact of left ventricular function and transaortic gradient on outcomes from transcatheter aortic valve implantation: data from the UK TAVI Registry

Abstract

Neither low EF nor low gradient affected procedural success or 30-day mortality. Long-term survival was reduced in LEF-LG patients but not in those with low EF and high gradient or P-LG with normal EF.

Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

“…For instance, an analysis of 2535 patients from the UK‐TAVR registry found reduced midterm survival in patients with LG and EF <50%, whereas patients with normal MPG or preserved EF did not exhibit increased mortality at 2 years 10. A study with 3908 patients from the German Aortic Valve Registry yielded similar results 9.…”

“…LV ejection fraction (LV‐EF) has affected survival after surgical aortic valve replacement2, 3, 4 and has consequently been incorporated in statistical models for assessment of operative risk 5. Conversely, in transcatheter aortic valve replacement (TAVR), which has been a safe and effective treatment for patients at intermediate6 and high surgical risk,7 the relationship is less clear 8, 9, 10, 11, 12…”

“…LF states are associated with either poor prognosis, if treated medically,16 or with increased operative mortality, if treated by surgical aortic valve replacement16, 17, 18 or TAVR 19. Data in TAVR cohorts are characterized by different definitions of AS entities and missing information on SVI, leading to an inconclusive assessment on the impact of LV‐EF, mean pressure gradient (MPG), and SVI on outcome 1, 9, 10, 19, 20, 21, 22, 23. Beyond survival, it is also recognized that some patients fail to experience a benefit in functional capacity or morbidity after TAVR 24.…”

Impact of baseline left ventricular ejection fraction on outcome after transfemoral transcatheter aortic valve implantation in patients with and without low‐gradient aortic stenosis

“…Similar to our findings, the combination of LGAS with a LVEF <40% was predictive of increased mortality (HR: 2.4) at a median follow-up of 396 days after TAVI 4. Likewise, in the UK-TAVI registry, abnormal LVEF (<50%) was associated with an increased mortality at 2-year follow-up after TAVI only in patients with low-gradient AS (defined as a peak transvalvular aortic gradient <64 mm Hg), while in the subgroup of patients with normal LVEF, there was no difference in 2-year mortality after TAVI in patients with LGAS and those with high gradients 3. One-year mortality in this subgroup was 38% in one study,26 which is similar to the 1-year mortality of 37% seen in our patients with moderately/severely abnormal LVEF andLGAS.…”

“…3,4,[8][9][10] The American Society of Echocardiography (ASE) and the European Association for Cardiovascular Imaging (EACVI) have proposed a classification for LVEF into normal (>51% in male and >53% in female), mildly abnormal (>40%-51% in male and to 53% in female), moderately abnormal (≥30%-≤40%), and severely abnormal (<30%) thus including different thresholds for males and females. 3,4,[8][9][10] The American Society of Echocardiography (ASE) and the European Association for Cardiovascular Imaging (EACVI) have proposed a classification for LVEF into normal (>51% in male and >53% in female), mildly abnormal (>40%-51% in male and to 53% in female), moderately abnormal (≥30%-≤40%), and severely abnormal (<30%) thus including different thresholds for males and females.…”