Abstract 19770: TAVR Versus Medical Management Among Patients With Severe Aortic Stenosis and Left Ventricular Systolic Dysfunction
Background: The decision for transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) and left ventricular systolic dysfunction (LSVD) can be challenging. We sought to evaluate mortality differences in patients with AS and LVSD undergoing TAVR compared with a medically matched historical cohort.
Methods: We studied 206 patients who underwent TAVR and had an echocardiogram that demonstrated LVSD within six months prior to the procedure and a matched medically managed historical cohort (n = 206). All TAVR patients had severe aortic stenosis and high or extreme risk for open surgical AVR as determined by the Duke multidisciplinary team. Patients were matched 1:1 using optimal matching methods by AS resting mean gradient and/or peak velocity, age, gender, LVEF, and EURO score. LVSD was subclassified into mild (LVEF 36-50%) or severe (LVEF ≤35%). We used Cox multivariable modeling to assess the relationship between TAVR and all-cause mortality censored at 3 years.
Results: The median age of the cohort was 82 (IQR 76-87). Compared with the medically matched cohort, TAVR patients were more likely to be male, have a history of ischemic heart disease, renal insufficiency, CHF, and prior CABG (all p<0.05). TAVR was associated with mortality reduction compared with medical management (HR 0.26, 95% CI 0.17-0.40, p<0.0001), which persisted after multivariable adjustment (HR 0.19, 95% CI 0.12-0.30, p<0.0001) (Figure). After adjustment, TAVR provided a larger decrease in mortality risk in patients with LVEF ≤ 35% (HR 0.25, 95%CI 0.06-1.01), than in patients with LVEF 36-50% (HR 0.42, 95%CI 0.14-1.27), but this difference did not reach statistical significance (pinteraction= 0.52).
Conclusion: Compared with medical management, TAVR is associated with higher survival with a trend for benefit in patients with severe LVSD. Given the poor prognosis associated with medical management, TAVR should be explored as a therapeutic option in patients with AS and LSVD.
Author Disclosures: A.N. Vora: None. J.K. Harrison: Research Grant; Significant; Medtronic. A. Dunning: None. P. Schulte: None. M.W. Sherwood: Research Grant; Modest; AstraZeneca. J. Kisslo: Speakers Bureau; Significant; Phillips. G.C. Hughes: None. F.A. Alenezi: None. E. Velazquez: Research Grant; Significant; Abbott Vascular, Ikaria Pharmaceuticals. Honoraria; Significant; Novartis. Z. Samad: Research Grant; Significant; American Society of Echocardiography Grant, BD-STAR.
- © 2015 by American Heart Association, Inc.