Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation

Giuseppe Ferrante, Patrizia Presbitero, Paolo Pagnotta, Anna Sonia Petronio, Nedy Brambilla, Federico De Marco, Claudia Fiorina, Cristina Giannini, Fabrizio D'Ascenzo, Silvio Klugmann, Marco L. Rossi, Federica Ettori, Francesco Bedogni, Luca Testa

Research output: Contribution to journalArticle

Abstract

Background: Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction (LVEF) on mortality after TAVI. Methods: Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF ≤ 30% on mortality was assessed by Cox regression. Results: Patients with LVEF ≤ 30% (n = 63), as compared to those with LVEF > 30% (n = 586), had a higher prevalence of NHYA class > 2 (P <0.001) and presented with a higher Euroscore (P <0.001). Procedural success was similar in both groups (98.4% vs. 97.2%, P = 1). After a median follow-up of 436 days (25th-75th percentile, 357-737 days), all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios (HR): 0.96, 95% confidence intervals (CI): 0.56-1.63] and cardiac mortality (19.1% vs. 17.6%, P = 0.89, HR: 1.04, 95% CI: 0.57-1.90) were similar in patients with LVEF ≤ 30% as compared to those with LVEF > 30%. Thirty-day all-cause mortality was not significantly different between the two groups (11.1% vs. 6.3%, P = 0.14, HR: 1.81, 95% CI: 0.81-4.06). Patients with LVEF ≤ 30% had a trend toward higher risk of 30-day cardiac mortality (11.1% vs. 5.3%; P = 0.06, HR: 2.16, 95% CI: 0.95-4.90), which disappeared after multivariable adjustment (P = 0.22). Conclusions: Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.

Original languageEnglish
Pages (from-to)290-298
Number of pages9
JournalJournal of Geriatric Cardiology
Volume13
Issue number4
DOIs
Publication statusPublished - 2016

Keywords

  • Left ventricular ejection fraction
  • Mortality
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Geriatrics and Gerontology

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