Association of Change in Ejection Fraction and Outcomes in Transcatheter Aortic Valve Replacement Patients with Left Ventricular Dysfunction

Background and aim of the study: The study aim was to evaluate the association between immediate postoperative improvement in left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR) and postoperative all-cause mortality.

Methods: A total of 234 TAVR patients with LVEF <50% was analyzed. LVEF was measured using transthoracic echocardiography preoperatively and at 24 h prior to discharge. Patients were allocated to three groups: LVEF improvement >10%; no improvement (increase or decline <10% of preoperative LVEF); and LVEF decline >10%. Predictors of immediate LVEF improvement were investigated using multivariable logistic regression. Cox regression analysis was used to evaluate predictors of all-cause mortality.

and 11 (5%) had a decline of >10%. The median postoperative follow up duration was 16 months. Factors associated with immediate improvement in LVEF after TAVR were: no aortic regurgitation (AR) before procedure; female gender; low body mass index (BMI); and NYHA functional class III/IV. LVEF was not associated with improved survival (HR 1.08, 95% CI 0.59-1.95, p = 0.81). Independent risk factors for post-TAVR mortality were peripheral vascular disease (HR 4.91, 95% 2.23-10.81, p <0.001) and moderate/severe paravalvular leak (HR 1.98, 95% CI 1.05-3.74, p = 0.03).

Conclusion: Most TAVR patients experience an improvement in LVEF during the postoperative period. Patients with no AR preoperatively, a lower BMI and NYHA class III/IV, or of female gender, are likely to observe an immediate improvement, but this does not translate into improved postoperative survival.

The Journal of Heart Valve Disease 2018-19;27:213-220