Impact of Left Ventricular Ejection Fraction on Outcomes Following Transcatheter Aortic Valve Implantation

Abstract

Background: We aimed to evaluate outcomes after transcatheter aortic valve implantation (TAVI) based on LVEF. Methods: Between 2008 and 2017, all patients who underwent TAVI in two experienced centres in Melbourne were prospectively included in a registry. Baseline, peri-procedural characteristics and outcomes were compared using Valve Academic Research Consortium (VARC)-2 criteria. Patients were stratified to LVEF <50% and LVEF ≥50%. The primary end-point was 1-year mortality. Results: Of 535 patients, 89 (16.6%) had a LVEF <50%. Patients with LVEF <50% were younger (83 vs. 85, p = 0.002), more often male (70% vs. 46%, p < 0.001), more often had concomitant CAD (60% vs. 41%, p < 0.001), moderate-severe MR (24% vs. 11%, p = 0.002) and low-gradient severe AS (51% vs. 15%, p < 0.001). Mortality was similar in both groups at 30-days (LVEF <50%: 1.1% vs. LVEF ≥50%: 0.9%, p = 0.99) and at 1-year (LVEF <50%: 10.7% vs. LVEF ≥50%: 7.1% p = 0.29). Multivariate analysis demonstrated that LVEF was not an independent predictor of poorer outcomes at 1-year (LVEF <50%: OR = 1.27, 95%CI 0.51-3.14, p = 0.60). Other VARC-2 outcomes including acute myocardial infarction, stroke, major bleed, access site complications, acute kidney injury and conduction disturbances requiring PPM insertion (p = NS). Conclusion: Patients with LVEF<50% are a significantly different patient population in terms of baseline characteristics. However, short-term and medium-term outcomes remain similar to patients with a LVEF ≥50%.