4yr
Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction: A single centre pilot study
Source : https://www.sciencedirect.com/science/article/pii/S2049080122004721?via=ihub
This is the first reported outcome study of TAVR in patients with heart failure in Kuwait. * Conduction disturbances induced by TAVR was observed in almost half of the patients. * Systolic dysfunction was not a predictor of in hospital complications or mortality outcomes.
Conclusion: Severe AS with EF
• Source: Annals of Medicine and Surgery
• Conclusion: “This is the first reported outcome study of TAVR in patients with HFrEF in Kuwait. Post-TAVR conduction disturbances were observed in almost half of patients with systolic dysfunction. In addition, requirement for pacemaker implantation was observed in both subgroups, regardless of the LVEF%. In terms of their in-hospital outcomes, systolic dysfunction was not a predictor of mortality. This association needs to be further clarified by future follow-up and additional studies.”
• Patients with HFrEF make up many high-risk patients referred for TAVR. It’s important to establish prognostic parameters related to patient outcomes. In the current study, investigators aimed to elucidate baseline characteristics and echo/CT parameters in 61 Kuwaiti patients with severe AS who received TAVR, as well as overall outcomes.
• The researchers performed a retrospective review of patient parameters including pre-, intra-, and post-procedural data. They grouped the patients into 2 subgroups: EF <40% (HFrEF) and EF ≥ 40%.
• Overall, patients with systolic dysfunction made up 20% of patients with severe AS receiving TAVR. Baseline characteristics were not significantly different between the subgroups, but more patients with heart failure had a history of PCI. This finding suggests increased comorbidity of coronary artery disease and later systolic dysfunction in HF patients.
• “In regards to their baseline echocardiography, both peak aortic velocity and mean aortic gradient were significantly lower in patients with heart failure, implying the presence of a low-flow low-gradient state. Pre-procedural CT further revealed a higher degree of valvular calcifications in patients with systolic dysfunction, further contributing to the low-flow low-gradient state,” the authors wrote.
• Preprocedural CT exhibited a higher degree of valvular calcifications in individuals with systolic dysfunction, thus playing a role in low-flow low-gradient state.
• Limitations of the current study include the small sample size due to single-center design, decreased follow-up time, and selection bias/interobserver variability due to different specialists evaluating echo results.