Abstract 3034: Comparison Between Surgical and Transcatheter Prosthetic Valve Implantation in Patients With Severe Aortic Stenosis and Reduced Left Ventricular Ejection Fraction
Background: Patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) have a poor prognosis with conservative therapy but a high operative mortality when treated surgically. Recently, Transcatheter Aortic Valve Implantation (TAVI) has emerged as an alternative to Surgical Aortic Valve Replacement (SAVR) for patients with symptomatic severe AS considered at high or prohibitive operative risk. The aim of this study was to compare postoperative recovery of LVEF in patients with severe AS and reduced LV systolic function.
Method: We compared echocardiographic data prospectively collected before and after procedure in 200 patients undergoing SAVR and 83 patients undergoing TAVI for severe AS (Aortic Valve Area [AVA] <1cm2) with reduced LV systolic function (LVEF <50%).
Result: TAVI patients were older (81±8 vs. 70±10 years, p<0.001), had a smaller aortic annulus diameter (20.7±1.9 vs. 22.0±2.2 mm, p<0.001) and had more comorbidities (Euroscore 32±18 vs. 17±14%, p<0.001). TAVI was associated with a better improvement in AVA (ΔAVA [AVA at 1 year - AVA at baseline]= + 0.74±0.31 vs. +0.58±0.41 cm2, p<0.001) and mean gradient (ΔMG=−27±14 vs. −18±16 mmHg, p<0.01). Postoperative prevalence of mild aortic regurgitation was higher in the TAVI group (24% vs. 4%, p<0.001). Despite similar baseline LVEF (35±9% vs. 36±11%), TAVI patients had better recovery compared to SAVR patients (ΔLVEF= +16±15 vs. +9±11 %, p=0.03).
Conclusion: In patients with severe AS and reduced LV function, TAVI is associated with better hemodynamic results and recovery of LVEF compared to SAVR. TAVI may provide a promising alternative to SAVR in this high-risk population.