Author + information
- Chase R. Browna,b,
- Robert Lia,b,
- Saif Anwaruddina,b,
- Nimesh Desaia,b,
- Prashanth Vallabhajosyulaa,b,
- Jay Giria,b,
- Howard Herrmanna,b,
- Joseph Bavariaa,b,
- Wilson Szetoa,b and
- Matthew Williamsa,b
Background: Patients with a very low ejection fraction (EF) have been excluded from major TAVR trials. As a consequence, the safety and efficacy of TAVR in this cohort remains uncertain. In this study, patients with pre-TAVR EF≤20% were analyzed to determine survival and effects on cardiac function post-TAVR.
Methods: From 2008 to 2016, 895 patients underwent TAVR at our center, of whom 35 (3.9%) had an EF≤20%. Patient records were retrospectively examined for pre and post-TAVR EF, left ventricular end systolic diameters (LVESD), and left ventricular end diastolic diameters (LVEDD). Overall survival, using Kaplan-Meier, and change in mean EF%, LVEDD, and LVESD, using Wilcoxon test, were calculated.
Results: Average age was 80.5±9.4 years with mean pre-TAVR EF% of 17±3% and mean aortic valve gradient of 41±8 mmHg. Median follow up was 11.9 (range: 0 – 78.9) months. Overall survival was 94% at two year follow up, with only two deaths: one intraoperative death and one death at 1.2 months. Post-TAVR, there were significant increases in EF at one and two years (Figure 1) and improvements in left ventricular remodeling. Mean LVESD decreased from 5.0±0.9 cm to 4.3±1.0 cm (p=0.03) and mean LVEDD decreased from 5.8 ± 0.7 cm to 5.2 ± 1.0 cm (p=0.007) at one year.
Conclusions: TAVR appears to be safe and effective in patients with very low EF. After TAVR, patients with EF ≤ 20% had reasonable survival and underwent significant improvement in both EF and left ventricular remodeling. Low EF alone should not be a contraindication to 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: 1114-155
- 2017 American College of Cardiology Foundation