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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Transcatheter heart valve selection in patients with low ejection fraction and aortic stenosis

Ahmad Mustafa1, Chad Kliger2, Luigi Pirelli2

  • 1Department of Cardiovascular & Thoracic Surgery, Staten Island University Hospital/Northwell Health, New York, New York, USA.

Journal of Cardiac Surgery
|November 15, 2022
PubMed

Insights

Transcatheter heart valve choice in patients with severe aortic stenosis and systolic dysfunction showed similar clinical outcomes. Case-by-case evaluation is recommended for transcatheter aortic valve replacement (TAVR) device selection.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Management of congestive heart failure with severe aortic stenosis (AS) and left ventricular (LV) systolic dysfunction is complex.
  • Transcatheter aortic valve replacement (TAVR) is a viable treatment for this patient subgroup.
  • Limited head-to-head data exists comparing balloon-expandable (BEV) and self-expandable (SEV) transcatheter heart valves (THV) in this population.

Purpose of the Study:

  • To compare outcomes between BEV and SEV THV in patients with severe AS and LV systolic dysfunction (LVEF ≤40%).
  • To evaluate the impact of THV choice on clinical endpoints and quality of life.

Main Methods:

  • Retrospective analysis of 335 patients with severe AS and LVEF ≤40% who underwent TAVR at four high-volume centers.
  • Patients received either SEV (n=146) or BEV (n=189) THV.
  • Primary composite endpoint included in-hospital mortality, moderate/greater paravalvular leak (PVL), stroke, conversion to open surgery, reintervention, and permanent pacemaker (PPM) need.

Main Results:

  • No significant difference in the primary composite endpoint between SEV and BEV groups.
  • Higher rates of PVL observed with SEV, while higher transaortic gradients were noted with BEV.
  • Similar clinical outcomes and quality of life measures observed up to 1-year follow-up.

Conclusions:

  • THV choice in severe AS with systolic dysfunction does not significantly impact key clinical outcomes at 1 year.
  • Consideration of specific valve characteristics, such as PVL and gradients, is important for individualized patient selection.
  • Case-by-case decision-making is crucial for optimal TAVR device selection in this challenging patient group.
Abstract

Keywords:
aortic stenosis (AS)balloon-expandable transcatheter heart valves (BEV)self-expandable transcatheter heart valves (SEV)transcatheter aortic valve replacement (TAVR)

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