Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Severe aortic stenosis with left ventricular systolic dysfunction indicates a poor prognosis, potentially impacting survival post-aortic valve replacement.
• Investigating comparative outcomes of transcatheter and surgical aortic valve replacement is crucial for this patient group.

Purpose of the Study:

• To compare the outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF).

Main Methods:

• Retrospective analysis of the nationwide FinnValve registry data.
• Included patients underwent TAVR or SAVR with a bioprosthesis for severe aortic stenosis.
• Propensity score matching was used to adjust for baseline covariates in patients with reduced LVEF (≤50%).

Main Results:

• Reduced LVEF was present in 20.8% of the surgical cohort and 27.7% of the TAVR cohort.
• Reduced LVEF was associated with decreased survival (aHR 1.215) after a mean follow-up of 3.6 years.
• In propensity score matched pairs, 30-day mortality was significantly lower after TAVR (3.1%) compared to SAVR (7.8%). One- and 4-year survival rates were comparable between TAVR and SAVR.

Conclusions:

• Reduced LVEF is linked to increased morbidity and mortality following both SAVR and TAVR.
• While SAVR had higher 30-day mortality, intermediate-term survival was comparable between SAVR and TAVR.
• The FinnValve registry (ClinicalTrials.gov Identifier: NCT03385915) provides insights into these comparative outcomes.