Eight-Year Outcomes of Patients With Reduced Left Ventricular Ejection Fraction Who Underwent Transcatheter Aortic Valve Replacement With a Self-Expanding Bioprosthesis

• Published in: The American journal of cardiology 2024-12, Vol.232, p.57-64
• Main Authors: De Felice, Francesco, Paolucci, Luca, Musto, Carmine, Nazzaro, Marco Stefano, Chin, Diana, Stio, Rocco, Pennacchi, Mauro, Adamo, Marianna, Chizzola, Giuliano, Massussi, Mauro, Giannini, Cristina, Angelillis, Marco, De Carlo, Marco, Gorla, Riccardo, Bedogni, Francesco, Bellini, Barbara, Montorfano, Matteo, Bruschi, Giuseppe, Merlanti, Bruno, Ferrara, Erica, Poli, Arnaldo, Regazzoli, Damiano, Palmerini, Tullio, Iadanza, Alessandro, Nicolini, Elisa, Toselli, Marco, De Marco, Federico, Gabrielli, Domenico
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angioplasty; Aorta; Aortic stenosis; Aortic valve; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Bioprosthesis; Cardiovascular disease; Cause of Death - trends; Chronic obstructive pulmonary disease; Clinical outcomes; Composers; Coronary vessels; Death; Diabetes; Ejection fraction; Estimates; Etiology; Female; Follow-Up Studies; Gender; Heart; Heart surgery; Heart Valve Prosthesis; Heart valves; Humans; Ischemia; Italy - epidemiology; Male; Medical prognosis; Mortality; Older people; Patient Readmission - statistics & numerical data; Prospective Studies; Prosthesis Design; Pulmonary hypertension; Stroke Volume - physiology; TAVR, reduced left ventricular ejection fraction; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2024.09.015

Data deriving from patients who underwent TAVR between 2007 and 2017 in 13 Italian centers were prospectively collected. Patients were stratified in those with normal LVEF and reduced LVEF. The latter was further classified according to ischemic or nonischemic etiology. The primary end point was a composite of all-cause death and rehospitalizations; the secondary end points were the isolated composers of the primary end point and cardiac death. Overall, 2,626 patients were included in the analysis: 68.1% with normal LVEF and 31.9% with reduced LVEF. At 8 years, reduced LVEF was significantly associated with the primary end point (adjusted hazard ratio 1.17, 95% confidence interval 1.06 to 1.29). Consistent findings were evident for the composite end point. No differences in these trends were found at the 30-day landmark analyses. Compared with nonischemic etiology, ischemic reduced LVEF was associated with an increased risk of cardiac death (adjusted hazard ratio 1.43, 95% confidence interval 1.02 to 2.02). In conclusion, patients with reduced LVEF who underwent TAVR are exposed to a progressively increased risk of death and rehospitalizations, even at very long-term follow-up.