Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40%
Treatment of congestive heart failure (CHF) with left ventricular (LV) systolic dysfunction and severe aortic stenosis (AS) is challenging, yet transcatheter aortic valve replacement (TAVR) has emerged as a suitable treatment option in such patients. We compared the periprocedural outcomes of TAVR i...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-03-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/12/6/2390 |
| _version_ | 1797610957264912384 |
|---|---|
| author | Arber Kodra Michael Cinelli Renita Alexander Rahming Hamfreth Denny Wang Shankar Thampi Craig Basman Chad Kliger Jacob Scheinerman Luigi Pirelli |
| author_facet | Arber Kodra Michael Cinelli Renita Alexander Rahming Hamfreth Denny Wang Shankar Thampi Craig Basman Chad Kliger Jacob Scheinerman Luigi Pirelli |
| author_sort | Arber Kodra |
| collection | DOAJ |
| description | Treatment of congestive heart failure (CHF) with left ventricular (LV) systolic dysfunction and severe aortic stenosis (AS) is challenging, yet transcatheter aortic valve replacement (TAVR) has emerged as a suitable treatment option in such patients. We compared the periprocedural outcomes of TAVR in patients with an ejection fraction (EF) of ≤20% (VLEF group) to patients with an EF > 20% to ≤40% (LEF group). We included patients with severe AS and reduced LV ejection fraction (LVEF ≤ 40%) who underwent TAVR at four centers within Northwell Health between January 2016 and December 2020. Over 2000 consecutive patients were analyzed, of which 355 patients met the inclusion criteria. The primary composite endpoint was in-hospital mortality, moderate or greater paravalvular (PVL), stroke, conversion to open surgery, aortic valve re-intervention, and/or need for PPM. Secondary endpoints were length of stay, NYHA classification at 1 month and 1 year, mortality at 1 month and 1 year, mean valve gradient at 1 month, KCCQ score at 1 month, and ≥ moderate PVL at 1 month. There was no difference in the primary composite endpoint between the two groups (23.6% for VLEF vs. 25.3% for LEF, <i>p</i> = 0.29). During TAVR placement, 40% of patients in the VLEF group required ≥1 vasopressors for hypotension lasting ≥30 min vs. only 21% of patients in the LEF group (<i>p</i> < 0.01). Intra-aortic balloon pump (IABP) use during procedure was greater in the VLEF group (9% vs. 1%, <i>p</i> < 0.01)—all placed post TAVR. Emergency ECMO use was higher in the VLEF group as well (5% vs. 0%). Total length of stay was significantly different between the two groups as well (6 days vs. 3 days, <i>p</i> < 0.01). Both groups had a change in LVEF of ~10%. One-year outcomes were similar between the groups. All-cause mortality at 1 year was not significantly different at 1 year (13% for VLEF vs. 11% for LEF), and KCC scores were also similar (77.54 vs. 74.97). Mean aortic valve gradients were also similar (12 mmHg vs. 11 mmHg, <i>p</i> = 0.48). Our study suggests that patients with EF ≤ 20% can safely have TAVR with similar periprocedural outcomes compared to patients with EF > 20% to ≤40% despite higher rates of vasopressor and mechanical support. |
| first_indexed | 2024-03-11T06:22:10Z |
| format | Article |
| id | doaj.art-8260f1a7572c4054807b127acd2a7a91 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T06:22:10Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-8260f1a7572c4054807b127acd2a7a912023-11-17T11:52:13ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01126239010.3390/jcm12062390Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40%Arber Kodra0Michael Cinelli1Renita Alexander2Rahming Hamfreth3Denny Wang4Shankar Thampi5Craig Basman6Chad Kliger7Jacob Scheinerman8Luigi Pirelli9Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USADepartment of Cardiology, Staten Island University Hospital, Staten Island, NY 10305, USADepartment of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USADepartment of Cardiology, Staten Island University Hospital, Staten Island, NY 10305, USADepartment of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USADepartment of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USADepartment of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USADepartment of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USADepartment of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USADepartment of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USATreatment of congestive heart failure (CHF) with left ventricular (LV) systolic dysfunction and severe aortic stenosis (AS) is challenging, yet transcatheter aortic valve replacement (TAVR) has emerged as a suitable treatment option in such patients. We compared the periprocedural outcomes of TAVR in patients with an ejection fraction (EF) of ≤20% (VLEF group) to patients with an EF > 20% to ≤40% (LEF group). We included patients with severe AS and reduced LV ejection fraction (LVEF ≤ 40%) who underwent TAVR at four centers within Northwell Health between January 2016 and December 2020. Over 2000 consecutive patients were analyzed, of which 355 patients met the inclusion criteria. The primary composite endpoint was in-hospital mortality, moderate or greater paravalvular (PVL), stroke, conversion to open surgery, aortic valve re-intervention, and/or need for PPM. Secondary endpoints were length of stay, NYHA classification at 1 month and 1 year, mortality at 1 month and 1 year, mean valve gradient at 1 month, KCCQ score at 1 month, and ≥ moderate PVL at 1 month. There was no difference in the primary composite endpoint between the two groups (23.6% for VLEF vs. 25.3% for LEF, <i>p</i> = 0.29). During TAVR placement, 40% of patients in the VLEF group required ≥1 vasopressors for hypotension lasting ≥30 min vs. only 21% of patients in the LEF group (<i>p</i> < 0.01). Intra-aortic balloon pump (IABP) use during procedure was greater in the VLEF group (9% vs. 1%, <i>p</i> < 0.01)—all placed post TAVR. Emergency ECMO use was higher in the VLEF group as well (5% vs. 0%). Total length of stay was significantly different between the two groups as well (6 days vs. 3 days, <i>p</i> < 0.01). Both groups had a change in LVEF of ~10%. One-year outcomes were similar between the groups. All-cause mortality at 1 year was not significantly different at 1 year (13% for VLEF vs. 11% for LEF), and KCC scores were also similar (77.54 vs. 74.97). Mean aortic valve gradients were also similar (12 mmHg vs. 11 mmHg, <i>p</i> = 0.48). Our study suggests that patients with EF ≤ 20% can safely have TAVR with similar periprocedural outcomes compared to patients with EF > 20% to ≤40% despite higher rates of vasopressor and mechanical support.https://www.mdpi.com/2077-0383/12/6/2390transcatheter aortic valve replacementlow ejection fractioninotropesassist devices |
| spellingShingle | Arber Kodra Michael Cinelli Renita Alexander Rahming Hamfreth Denny Wang Shankar Thampi Craig Basman Chad Kliger Jacob Scheinerman Luigi Pirelli Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40% Journal of Clinical Medicine transcatheter aortic valve replacement low ejection fraction inotropes assist devices |
| title | Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40% |
| title_full | Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40% |
| title_fullStr | Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40% |
| title_full_unstemmed | Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40% |
| title_short | Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction ≤ 20% vs. Patients with 20% < EF ≤ 40% |
| title_sort | comparison of periprocedural and intermediate term outcomes of tavi in patients with ejection fraction ≤ 20 vs patients with 20 ef ≤ 40 |
| topic | transcatheter aortic valve replacement low ejection fraction inotropes assist devices |
| url | https://www.mdpi.com/2077-0383/12/6/2390 |
| work_keys_str_mv | AT arberkodra comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT michaelcinelli comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT renitaalexander comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT rahminghamfreth comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT dennywang comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT shankarthampi comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT craigbasman comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT chadkliger comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT jacobscheinerman comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 AT luigipirelli comparisonofperiproceduralandintermediatetermoutcomesoftaviinpatientswithejectionfraction20vspatientswith20ef40 |