Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation
Patients with symptomatic aortic stenosis (AS) can have concomitant systolic heart failure (HF) that persists even after correction of afterload by transcatheter aortic valve implantation (TAVI). These patients qualify as potential candidates for prophylactic therapy with an implantable cardioverter...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/13/2929 |
| _version_ | 1797411386386546688 |
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| author | Ulrich Fischer-Rasokat Matthias Renker Christoph Liebetrau Maren Weferling Andreas Rolf Andreas Hain Johannes Sperzel Yeong-Hoon Choi Christian W. Hamm Won-Keun Kim |
| author_facet | Ulrich Fischer-Rasokat Matthias Renker Christoph Liebetrau Maren Weferling Andreas Rolf Andreas Hain Johannes Sperzel Yeong-Hoon Choi Christian W. Hamm Won-Keun Kim |
| author_sort | Ulrich Fischer-Rasokat |
| collection | DOAJ |
| description | Patients with symptomatic aortic stenosis (AS) can have concomitant systolic heart failure (HF) that persists even after correction of afterload by transcatheter aortic valve implantation (TAVI). These patients qualify as potential candidates for prophylactic therapy with an implantable cardioverter defibrillator (ICD). We compared survival between patients with or without an ICD after successful TAVI. This retrospective study analyzed Kaplan-Meier survival data during a follow-up period of three years in two populations: (a) patients with a left ventricular ejection fraction (LVEF) ≤ 35% before TAVI (overall population); (b) patients with additionally documented LVEF ≤ 35% 3 months after TAVI (persistent LV dysfunction subpopulation). In the overall population, 53 patients with and 193 patients without an ICD had similar baseline characteristics and procedural success rates, and HF medication at discharge was comparable. Three-year mortality rates were 26.4% for patients with an ICD and 24.4% for patients without an ICD (<i>p</i> = 0.758). Cardiovascular death rates were similar between groups (<i>p</i> = 0.914), and deaths were most often attributed to worsening of HF. Survival rates in patients with persistent LV dysfunction with an ICD (<i>n</i> = 24) or without an ICD (<i>n</i> = 59) were similar between groups (<i>p</i> = 0.872), with cardiovascular deaths mostly qualified as worsening HF and none as sudden cardiac death. Patients of the overall study population with biventricular pacing devices showed only a tendency to have better outcomes (<i>p</i> = 0.298). ICD therapy in elderly patients with AS and LV dysfunction undergoing TAVI did not demonstrate a survival benefit during a 3-year follow-up period. |
| first_indexed | 2024-03-09T04:44:22Z |
| format | Article |
| id | doaj.art-d64e56789e3e42948ad28dc442e2d8f9 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T04:44:22Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d64e56789e3e42948ad28dc442e2d8f92023-12-03T13:17:33ZengMDPI AGJournal of Clinical Medicine2077-03832021-06-011013292910.3390/jcm10132929Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve ImplantationUlrich Fischer-Rasokat0Matthias Renker1Christoph Liebetrau2Maren Weferling3Andreas Rolf4Andreas Hain5Johannes Sperzel6Yeong-Hoon Choi7Christian W. Hamm8Won-Keun Kim9Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, GermanyPatients with symptomatic aortic stenosis (AS) can have concomitant systolic heart failure (HF) that persists even after correction of afterload by transcatheter aortic valve implantation (TAVI). These patients qualify as potential candidates for prophylactic therapy with an implantable cardioverter defibrillator (ICD). We compared survival between patients with or without an ICD after successful TAVI. This retrospective study analyzed Kaplan-Meier survival data during a follow-up period of three years in two populations: (a) patients with a left ventricular ejection fraction (LVEF) ≤ 35% before TAVI (overall population); (b) patients with additionally documented LVEF ≤ 35% 3 months after TAVI (persistent LV dysfunction subpopulation). In the overall population, 53 patients with and 193 patients without an ICD had similar baseline characteristics and procedural success rates, and HF medication at discharge was comparable. Three-year mortality rates were 26.4% for patients with an ICD and 24.4% for patients without an ICD (<i>p</i> = 0.758). Cardiovascular death rates were similar between groups (<i>p</i> = 0.914), and deaths were most often attributed to worsening of HF. Survival rates in patients with persistent LV dysfunction with an ICD (<i>n</i> = 24) or without an ICD (<i>n</i> = 59) were similar between groups (<i>p</i> = 0.872), with cardiovascular deaths mostly qualified as worsening HF and none as sudden cardiac death. Patients of the overall study population with biventricular pacing devices showed only a tendency to have better outcomes (<i>p</i> = 0.298). ICD therapy in elderly patients with AS and LV dysfunction undergoing TAVI did not demonstrate a survival benefit during a 3-year follow-up period.https://www.mdpi.com/2077-0383/10/13/2929aortic stenosisimplantable cardioverter defibrillatorsurvivalTAVI |
| spellingShingle | Ulrich Fischer-Rasokat Matthias Renker Christoph Liebetrau Maren Weferling Andreas Rolf Andreas Hain Johannes Sperzel Yeong-Hoon Choi Christian W. Hamm Won-Keun Kim Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation Journal of Clinical Medicine aortic stenosis implantable cardioverter defibrillator survival TAVI |
| title | Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation |
| title_full | Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation |
| title_fullStr | Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation |
| title_full_unstemmed | Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation |
| title_short | Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation |
| title_sort | long term survival in patients with or without implantable cardioverter defibrillator after transcatheter aortic valve implantation |
| topic | aortic stenosis implantable cardioverter defibrillator survival TAVI |
| url | https://www.mdpi.com/2077-0383/10/13/2929 |
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