Abstract 15853: Do Patients With Aortic Stenosis and Low Left Ventricular Ejection Fraction Benefit From Transcatheter Aortic Valve Replacement?
INTRODUCTION: Advanced left ventricular dysfunction associated with extensive myocardial fibrosis in aortic stenosis (AS) may be irreversible. These patients may not benefit from valve replacement. There are limited data to assess the outcome of patients with AS and low ejection fraction (EF) who undergo transcatheter aortic valve replacement (TAVR). This study aimed to assess left ventricular recovery and clinical outcomes of patients with low EF who undergo TAVR.
METHODS: Clinical data of patients with AS who underwent TAVR during 2007-2012 was retrospectively analyzed. Patients were divided into two groups according to left ventricular EF at baseline: Low EF (EF <45%) and preserved EF (EF >45%). Two-way ANOVA was used to assess change in EF in both groups.
RESULTS: 369 patients were included. Of them, 271 (73%) had preserved EF and 98 (27%) had low EF. Patient age was similar in both groups: 84±7 years. Patients with low EF were more likely to be male (64% vs. 43%, p <0.001), to have higher STS score (12±5 vs. 10±4, p <0.001), prior MI (30% vs. 9%, p <0.001), prior CABG (50% vs. 26%, p <0.001) and pacemaker/ICD (36% vs. 13%, p <0.001). Baseline echo showed significantly lower EF, (Figure 1) higher rates of moderate or severe RV dysfunction (39% vs. 12%, p <0.001), and moderate or severe MR (17% vs. 9%, p=0.04) in the low EF group. Despite the higher risk for low EF patients, TAVR complications and hospital course was not different from patients with preserved LV function. Furthermore, the short- and long-term outcomes of low EF patients were comparable to patients with preserved LV function. (Figure 2)
CONCLUSIONS: TAVR in low EF patients is a viable therapeutic option as the procedural hazards are similar to patients with preserved EF. Furthermore, low EF patients benefit from significant improvement in EF post procedure.
- © 2013 by American Heart Association, Inc.