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Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction: A
Joud Al Balool1, Mohammed Al Jarallah2, Rajesh Rajan2,3
1Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
Insights
Patients with heart failure with reduced ejection fraction (HFrEF) undergoing transcatheter aortic valve replacement (TAVR) show similar outcomes to those with preserved ejection fraction. This study analyzed baseline characteristics and procedural results for TAVR patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Severe aortic stenosis (AS) often coexists with heart failure, impacting patient prognosis.
- Transcatheter aortic valve replacement (TAVR) is a standard treatment for severe AS.
- Understanding baseline characteristics of heart failure patients undergoing TAVR is crucial for procedural planning and outcome prediction.
Purpose of the Study:
- To define baseline echocardiographic, electrocardiographic (ECG), and computed tomographic (CT) findings in patients with heart failure undergoing TAVR.
- To analyze procedural outcomes in patients with severe AS undergoing TAVR, comparing those with reduced ejection fraction (HFrEF) to those with preserved ejection fraction (PFrEF).
Main Methods:
- A retrospective review of 61 patients who underwent TAVR for severe AS between 2018 and 2021.
- Patients were categorized into two groups: HFrEF (ejection fraction [EF] <40%) and PFrEF (EF ≥40%).
- Analysis included baseline demographics, cardiac imaging (echocardiography, CT), ECG, and procedural outcomes (conduction disturbances, pacemaker implantation, in-hospital mortality).
Main Results:
- 12 out of 61 patients (20%) had HFrEF. These patients were younger, more frequently male, and had higher rates of coronary artery disease.
- Left ventricular hypertrophy and diastolic dysfunction were more prevalent in the HFrEF group.
- Post-TAVR conduction disturbances (LBBB) occurred in 41.7% of HFrEF patients, with 25% requiring permanent pacemaker implantation. No significant difference in in-hospital mortality was observed between groups.
Conclusions:
- Heart failure with reduced ejection fraction represents a significant subgroup of patients undergoing TAVR for severe AS.
- Preliminary findings suggest that post-operative conduction disturbances and in-hospital mortality do not significantly differ between HFrEF and PFrEF patients following TAVR.
- Further research is warranted to fully elucidate the long-term implications of HFrEF in TAVR candidates.
Introduction:
To define baseline echocardiographic, electrocardiographic (ECG) and computed tomographic (CT) findings of patients with heart failure undergoing transcatheter aortic valve replacement (TAVR) and analyze their overall procedural outcomes.
Methods:
Between 2018 and 2021, patients with severe aortic stenosis (AS) who performed transcatheter aortic valve replacement (TAVR) in Sabah Al Ahmad Cardiac Centre, Al Amiri Hospital were identified. A retrospective review of patients' parameters including pre-, intra-, and post-procedural data was conducted. Patients were grouped in 2 subgroups according to their EF: EF <40% (HFrEF) and EF ≥ 40%. The data included patients' baseline characteristics, electrocardiographic and echocardiographic details along with pre-procedural CT assessment of aortic valve dimensions. Primary outcomes including post-operative disturbances, pacemaker implantation and in-hospital mortality following TAVR were additionally analyzed.
Results:
A total of 61 patients with severe AS underwent TAVR. The mean age was 73.5 ± 9, and 21 (34%) of the patients were males. The mean ejection fraction (EF) was 55.5 ± 9.7%. Of 61 patients, 12 (20%) were identified as heart failure with reduced EF (<40%). These patients were younger, more often males, and were more likely to have coronary artery disease (75% versus 53.1%). Left ventricular hypertrophy and diastolic dysfunction was documented in 75% and 58.3% of patients with heart failure with reduced ejection fraction (HFrEF) respectively. Post TAVR conduction disturbances, with the commonest being LBBB was observed in 41.7%. Permanent pacemaker was implanted in 3 of patients with HFrEF (25%). There were no significant differences between the two groups with regards to in hospital mortality (p = 0.618).
Conclusion:
Severe AS with EF <40% constitute a remarkable proportion of patients undergoing TAVR. Preliminary results of post-operative conduction disturbances and in hospital mortality in HFrEF patients were concluded to not differ from patients with LVEF ≥40%.
