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Am J Cardiol. 2015 Mar 1;115(5):656-63. doi: 10.1016/j.amjcard.2014.12.019. Epub 2014 Dec 18.

Comparison of outcomes of patients with left ventricular ejection fractions ≤30% versus ≥30% having transcatheter aortic valve implantation (from the German Transcatheter Aortic Valve Interventions Registry).

Author information

1
Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany; Department of Cardiology, University Heart Center Eppendorf, Hamburg, Germany. Electronic address: u.schaefer@uke.de.
2
Department of Cardiology, Heart Center Ludwigshafen, Ludwigshafen, Germany.
3
Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
4
Department of Cardiology, Gemeinschaftskrankenhaus, Bonn, Germany.
5
Heart Center, University of Leipzig, Leipzig, Germany.
6
Institute of Myocardial Infarction Research, Ludwigshafen, Germany.
7
Cardioangiological Center Bethanien, Frankfurt am Main, Germany.
8
Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt am Main, Germany.
9
Internal Medicine I, University of Jena, Frankfurt am Main, Germany.
10
Department of Cardiology, Asklepios Clinics Sankt Georg, Hamburg, Germany.

Abstract

Transcatheter aortic valve implantation (TAVI) is rapidly evolving in Germany. Especially severe reduced left ventricular ejection fraction (LVEF) is known as a prominent risk factor for adverse outcome in open heart surgery. Thus, the data of the prospective multicenter German Transcatheter Aortic Valve Interventions Registry were analyzed for outcomes in patients with severe depressed LVEF. Data of 1,432 patients were consecutively collected after transcatheter aortic valve implantation. Patients were divided into 2 groups (A: LVEF ≤30%, n = 169, age 79.9 ± 6.7 years, logES 34.2 ± 17.8%; B: LVEF >30%, n = 1,263, age 82.0 ± 6.1 years, logES 18.9 ± 12.0%), and procedural success rates, New York Heart Association classification, and quality of life were compared at 30 days and 1 year, respectively. Technical success was achieved in 95.9% (A) and 97.6% (B). Survival and the New York Heart Association classification at 30 days demonstrated an excellent outcome in both groups. There was a significant improvement according to the self-assessment in health condition (0 to 100 scale) with a much larger gain in group A (28 vs 19 patients, p <0.0001). Nevertheless, low cardiac output syndrome (12.3% vs 5.9%, p <0.01) and resuscitation (10.4% vs 5.6%, p <0.05) were more frequently seen in group A, contributing to a higher mortality at 30 days (14.3% vs 7.2%) and 1 year (33.7% vs 18.1%, p <0.001). In conclusion, this real-world registry demonstrated a comparably high success rate for patients with severe reduced LVEF and an early improvement in functional status as demonstrated by substantial benefit, despite a doubled postprocedural mortality.

PMID:
25613664
DOI:
10.1016/j.amjcard.2014.12.019
[Indexed for MEDLINE]

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