Author + information
- Yohannes Aberra Bayissaa,b,
- Firas Zahra,b,
- Rami Kafaa,b,
- Hazim El-Haddada,b,
- Andres Vargas Estradaa,b,
- Chad Warda,b,
- Musab Alqasrawia,b and
- Gardar Sigurdssona,b
Background: Transcatheter aortic valve replacement (TAVR) has been established as a valid option for patient with symptomatic severe aortic stenosis (AS) deemed ineligible or too high-risk for surgical treatment. The prognostic value of right ventricular (RV) function in this group of patients is little known.
Methods: Cardiac computed tomography (CCT) data of 204 patients referred for TAVR was retrospectively collected from TAVR registry of University of Iowa Hospitals and Clinics. RV dysfunction is defined as ejection fraction (EF) < 40% by CCT. Overall mortality was compared amongst TAVR recipient and non-recipient in the presence or absence of RV dysfunction.
Results: Of all patients referred for the TAVR, 120 underwent the procedure. Mean follow-up was 325 days. The average age was 84.1±7.8 and 83.6 ±9.4 in TAVR and non-TAVR groups respectively. Patients were predominately white (85%) and nearly half were women (48%). The mean society of thoracic surgeons (STS) score was not statistically different between the groups (7.0±5.0 versus 8.0±5.7). However, there was more mitral stenosis in the non-TAVR group (p: 0.05). RVEF was 53.7±11.4% and 50.6±12.9% in TAVR and non-TAVR patients, respectively (p: 0.49). Fifteen percent of patients had RV dysfunction. Fifty-seven patients died at the end of the follow-up. RV dysfunction was associated with increased mortality (HR: 7.5, p: 0.006). However, TAVR was associated with decreased mortality in the entire cohort (HR: 0.35, 95% CI: 0.20–0.60, p: 0.000) as well as in patients with RV dysfunction (HR: 0.36, 95th CI: 0.21–0.63, p: 0.000). In patients who underwent TAVR, mortality was not different between patients with and without RV dysfunction (p: 0.19).
Conclusions: RV dysfunction predicts higher mortality in patients with severe AS but should not preclude selection for TAVR.
Figure 1: Survival of patient with RV dysfunction who did and did not undergo TAVR
Figure 2: Survival curve in patients with normal and reduced RV function who have undergone TAVR
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: TAVR 1
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1114-152
- 2017 American College of Cardiology Foundation