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Transcatheter Aortic Valve Replacement Outcomes Based on the Presence of Chronic Total Occlusion

Travis M Howard1, Eric P Cantey1, AbdulRahman A Abutaleb1

  • 1Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|March 21, 2020
PubMed

Insights

Chronic total occlusion (CTO) before transcatheter aortic valve replacement (TAVR) did not affect survival or functional outcomes. However, CTO was associated with lower left ventricular ejection fraction post-TAVR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Chronic total occlusion (CTO) is associated with poorer prognosis.
  • Percutaneous coronary intervention (PCI) for CTO has shown benefits, but its role before transcatheter aortic valve replacement (TAVR) is unclear.

Purpose of the Study:

  • To investigate the prognostic impact of pre-TAVR CTO on post-TAVR outcomes.
  • To evaluate the association between CTO and mortality, functional status, and left ventricular (LV) function after TAVR.

Main Methods:

  • Retrospective review of 783 consecutive TAVR cases.
  • Analysis of pre-TAVR angiograms for CTO presence.
  • One-year and long-term follow-up for mortality, functional status, and LV ejection fraction.

Main Results:

  • 12.6% of patients had a pre-TAVR CTO.
  • No significant association between CTO and one-year mortality, functional status, quality of life, or adverse events.
  • No difference in long-term survival between CTO and non-CTO groups.
  • LV ejection fraction was lower in the CTO group at baseline and one year.

Conclusions:

  • Pre-TAVR CTO does not impact mortality or functional improvement after TAVR.
  • CTO is associated with reduced LV ejection fraction both at baseline and one year post-TAVR.
  • The findings suggest CTO is not a significant prognostic factor for TAVR outcomes in elderly, high-risk patients.
Abstract

Keywords:
Chronic total occlusionClinical researchTranscatheter aortic valve replacement

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