Reduced Ejection Fraction: Is there an improvement after Transcatheter Aortic Valve Replacement?
Mahim Malik1, Muhammad Shareef1, Juan A. Crestanello1, Barry S. George2, Gregory D. Rushing1.
1Ohio State University, Columbus, OH, USA, 2Ohio State University, columbus, OH, USA.
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) has expanded the treatment of aortic stenosis to patients who were too sick for traditional open procedures. TAVR in low gradient, low ejection fraction patients has been an area of controversy. We sought to examine if there was a improvement in the ejection fraction (EF) of this cohort of patients after undergoing transcatheter aortic valve replacement.
METHODS: : Patients undergoing transcatheter aortic valve replacement at our institution between Jan 2012 and 2015 were reviewed. Those with ejection fraction less that 35 % were included in the study. These were sub-stratified into those with severely depressed EF (less than 20%) and EF 20-35%. Primary endpoints were EF measured on ECHO at immediate postoperative, 1 month and at 1 year follow up.
RESULTS: Forty seven patients with preoperative EF of less than 35% underwent TAVR procedure. Sixty -six percent of patients were male (n=31), with a mean age of 78.4 years (range 52-93 years). Forty-one patients (n=19) had undergone previous sternotomy. There was a statistically significant improvement in ejection fraction in postoperative echocardiograms performed within 24 hrs postoperatively (25% vs. 33%p-value 0.003), at one month (25% vs. 33.7% p-value 0.0043) and 1 year (25% vs 34.5% p-value 0.00036). When sub-stratifed to two groups i.e to EF less than 20%, vs. 20-35%, there was still a statistically significant improvement in EF between the two groups.
CONCLUSIONS: TAVR in low ejection fraction patients is safe and effective. It may also help improve ejection fraction in these patients, both in the immediate postoperative period as well as at 1 year followup. Whether this confers an improvement in overall survival or heart failure symptoms and readmissions remains to be seen.
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