हृदय रोग एवं निदान

Contemporary Results of Transcatheter Aortic Valve Implantation in Patients with a Low Ejection Fraction: Retrospective Analysis of a Single Center Experience

Abstract

Owais T, El Garhy M, Awada H, Abdulrahman M, Fuchs J, Schreiber M and Kuntze T

Background: Reduced ejection fraction may increase the complications after transcatheter aortic valve implantation (TAVI). We investigated the impact of low flow (LF) and low gradient (LG) on long term mortality after TAVI in addition to other predictors.

Methods: We included retrospectively 450 patients with EF <40%, whom underwent TAVI in central hospital Bad Berka, Germany between 2012 and 2018. Patients were divided in to 4 groups according to the aortic mean pressure gradient and stroke volume. All demographic parameters and clinical outcomes were compared among the groups. Binary logistic regression was used to identify the predictors of 1-year mortality.

Results: Overall 1-year mortality was 16.3%, the 30-days mortality was 11.9%, 8.6%, 14.3% and 5%, and the 1- year mortality was 19.9%, 13.7%, 24.5% and 6.7% in LFLG, LFHG, NFLG and NFHG respectively. Univariable predictors for 12-month mortality were: age, male gender, diabetes mellitus, dementia, peripheral vascular disease, atrial fibrillation, ejection fraction <25%, TAPSE <16 mm, pulmonary hypertension and LG. Multivariable analysis showed that pulmonary hypertension (OR 3.4; 95% CI: 1,7-6.7, p value 0.0001), diabetes (OR 3; 95% CI: 1.5-5.8, p value 0.001) and dementia (OR 28; 95% CI: 5.6-144, p value 0.0001) remained as independent predictors. Significant improvement in NYHA class was shown in 81.7%, 83.4%, 93.5% and 80%, in LFLG, LFHG, NFLG and NFHG respectively.

Conclusions: TAVI improved the quality of life in all subgroups. LG has an impact on the 1-year mortality. Diabetes, dementia and pulmonary hypertension are independent predictors of 1-year mortality.