Gerhard Schymik1, Panagiotis Tzamalis2, Valentin Herzberger2, Jens Bergmann2, Peter Bramlage3, Alexander Würth4, Lars Oliver Conzelmann5, Armin Luik2, Holger Schröfel6. 1. Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestrasse 90, 76133, Karlsruhe, Germany. gerhard.schymik@klinikum-karlsruhe.de. 2. Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestrasse 90, 76133, Karlsruhe, Germany. 3. Institute for Pharmacology and Preventive Medicine, Mahlow, Germany. 4. Medical Clinic III, Department of Cardiology, Vincentius Hospital Karlsruhe, Karlsruhe, Germany. 5. Helios Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany. 6. Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany.
Abstract
BACKGROUND: Previous studies into the effect of a reduced left ventricular ejection fraction (EF) on the short- and long-term prognosis of patients undergoing transcatheter aortic valve implantation (TAVI) have reported conflicting findings. We analysed data from the Karlsruhe TAVI registry with the aim of addressing this question. METHODS AND RESULTS: Patients with aortic stenosis undergoing TAVI were divided into sub-groups according to EF: severely reduced (<30%; n = 109), reduced (≥30 and ≤40%; n = 201), and mid-range/preserved (>40%; n = 1690). VARC complications at 30 days for the population with severely reduced EF did not differ in comparison to the patients with mid-range/preserved EF. Patients with severely reduced EF had a significantly lower survival at 48 h (91.7 vs. 99.0%; p < 0.001), at 30 days (84.4 vs. 95.8%; p < 0.001) and at 1 year (66.1 vs. 85.0%, p < 0.001) compared to those with mid-range/preserved EF. The risk of death increased with age, peripheral arterial disease, poor self-care and chronic renal failure in patients with severely reduced EF. CONCLUSIONS: Mortality post-TAVI was higher for patients with a reduced EF, although the excess comorbidity burden likely contributed to this. A reduced EF should not be considered a contraindication for TAVI per se, but the additional presence of comorbidity indicates increased risk for these patients.
BACKGROUND: Previous studies into the effect of a reduced left ventricular ejection fraction (EF) on the short- and long-term prognosis of patients undergoing transcatheter aortic valve implantation (TAVI) have reported conflicting findings. We analysed data from the Karlsruhe TAVI registry with the aim of addressing this question. METHODS AND RESULTS:Patients with aortic stenosis undergoing TAVI were divided into sub-groups according to EF: severely reduced (<30%; n = 109), reduced (≥30 and ≤40%; n = 201), and mid-range/preserved (>40%; n = 1690). VARC complications at 30 days for the population with severely reduced EF did not differ in comparison to the patients with mid-range/preserved EF. Patients with severely reduced EF had a significantly lower survival at 48 h (91.7 vs. 99.0%; p < 0.001), at 30 days (84.4 vs. 95.8%; p < 0.001) and at 1 year (66.1 vs. 85.0%, p < 0.001) compared to those with mid-range/preserved EF. The risk of death increased with age, peripheral arterial disease, poor self-care and chronic renal failure in patients with severely reduced EF. CONCLUSIONS: Mortality post-TAVI was higher for patients with a reduced EF, although the excess comorbidity burden likely contributed to this. A reduced EF should not be considered a contraindication for TAVI per se, but the additional presence of comorbidity indicates increased risk for these patients.
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