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Research Article
 
DOI:doi:10.11909/j.issn.1671-5411.2016.04.001
Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation
Giuseppe Ferrante,Patrizia Presbitero,Paolo Pagnotta,Anna Sonia Petronio,Nedy Brambilla,Federico De Marco4,Claudia Fiorina,Cristina Giannini,Fabrizio D’Ascenzo,Silvio Klugmann,Marco L Rossi,Federica Ettori,Francesco Bedogni,Luca Testa.Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantationJ Geriatr Cardiol 2016,13(4):290~298
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Authors:Giuseppe Ferrante1;Patrizia Presbitero1;Paolo Pagnotta1;Anna Sonia Petronio2;Nedy Brambilla3;Federico De Marco44;Claudia Fiorina5;Cristina Giannini6;Fabrizio D’Ascenzo7;Silvio Klugmann8;Marco L Rossi9;Federica Ettori10;Francesco Bedogni11;Luca Testa12

Author Affiliation:1.Department of Cardiovascular Medicine, Humanitas Research Hospital, Rozzano, Italy;2.Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;3.Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy;4.Department of Interventional Cardiology, Niguarda Ca’ Granda Hospital, Milan, Italy;5.Cardiothoracic Department, Spedali Civili di Brescia, Brescia, Italy;6.Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;7.Cardiothoracic Department, Ospedale Molinette, Torino, Italy;8.Department of Interventional Cardiology, Niguarda Ca’ Granda Hospital, Milan, Italy;9.Department of Cardiovascular Medicine, Humanitas Research Hospital, Rozzano, Italy;10.Cardiothoracic Department, Spedali Civili di Brescia, Brescia, Italy;11.Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy;12.Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy

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Abstract: Background Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction (LVEF) on mortality after TAVI. Methods Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF ≤ 30% on mortality was assessed by Cox regression. Results Patients with LVEF ≤ 30% (n = 63), as compared to those with LVEF > 30% (n = 586), had a higher prevalence of NHYA class > 2 (P < 0.001) and presented with a higher Euroscore (P < 0.001). Procedural success was similar in both groups (98.4% vs. 97.2%, P = 1). After a median follow-up of 436 days (25th–75th percentile, 357–737 days), all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios (HR): 0.96, 95% confidence intervals (CI): 0.56–1.63] and cardiac mortality (19.1% vs. 17.6%, P = 0.89, HR: 1.04, 95% CI: 0.57–1.90) were similar in patients with LVEF ≤ 30% as compared to those with LVEF > 30%. Thirty-day all-cause mortality was not significantly different between the two groups (11.1% vs. 6.3%, P = 0.14, HR: 1.81, 95% CI: 0.81–4.06). Patients with LVEF ≤ 30% had a trend toward higher risk of 30-day cardiac mortality (11.1% vs.5.3%; P = 0.06, HR: 2.16, 95% CI: 0.95–4.90), which disappeared after multivariable adjustment (P = 0.22). Conclusions Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.

Keywords:

Left ventricular ejection fraction; Mortality; Transcatheter aortic valve implantation
Received:July 12, 2015        Accepted:January 26, 2016   Published Online:April 16, 2016
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