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You are here: Contents > 2018-19 > Volume 27 Number 3 (2018-19) > AORTIC VALVE DISEASE > Association of Change in Ejection Fraction and Outcomes in Transcatheter Aortic Valve Replacement Patients with Left Ventricular Dysfunction

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

Alexis Kofi Okoh1,4, Dhaval Chauhan2, Setri Fugar3, Nathan Kang2, Nick Haik2, Bruce Haik1, Marc Cohen2, Chungeng Chen2, Mark J. Russo1,2

1Cardiovascular Research Unit, RWJ Barnabas Health-NBIMC, Newark, NJ, USA
2Department of Surgery, Rutgers University Medical School, Newark, NJ, USA
3Department of Cardiology, Rush University Medical Center, Chicago, IL, USA
4Electronic correspondence: disciple951@gmail.com

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.

Results: Among patients, 157 (67%) had postoperative LVEF improvement >10%, 66 (28%) had no improvement,

 

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

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

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