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Impact of prosthesis choice on mortality after transfemoral transcatheter aortic valve implantation in patients with reduced- versus preserved- left-ventricular ejection fraction

Session Poster Session 7

Speaker Karim El Chilali

Congress : ESC Congress 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease: Intervention
  • Session type : Poster Session
  • FP Number : P6473

Authors : K El Chilali (Essen,DE), HA Kahlert (Essen,DE), M Riebisch (Essen,DE), RI Mincu (Essen,DE), F Al-Rashid (Essen,DE), M Totzeck (Essen,DE), A Lind (Essen,DE), RA Janosi (Essen,DE), T Rassaf (Essen,DE), P Kahlert (Essen,DE)

Authors:
K El Chilali1 , HA Kahlert1 , M Riebisch1 , RI Mincu1 , F Al-Rashid1 , M Totzeck1 , A Lind1 , RA Janosi1 , T Rassaf1 , P Kahlert1 , 1University Hospital of Essen, West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine - Essen - Germany ,

Citation:

Background: Outcomes of transfemoral transcatheter aortic valve implantation (TF-TAVI) with a self-expanding (SEP) and a balloon-expandable prosthesis (BEP) seem to be comparable, though head-to-head comparisons, especially in certain patient subsets, are sparse. In addition, patients with a reduced left-ventricular ejection fraction (rEF, = 40%) appear to be at higher risk for an increased mortality after TF-TAVI than patients with a preserved left-ventricular ejection fraction (pEF). As it remains unclear, whether outcomes of patients with rEF differ between TF-TAVI using SEP and BEP, we sought to compare all-cause mortality of patients with rEF using a SEP or a BEP.

Methods: We retrospectively analyzed data of 679 single-center TF-TAVI patients, which were stratified by baseline ejection fraction (rEF versus pEF) and type of implanted prosthesis (SEP versus BEP). Patients were censored at death or completion of 1-year follow-up, whichever occurred first.

Results: Twenty-one percent of patients had rEF, and these patients had a higher 1-year mortality compared to patients with pEF (28% vs. 19%, p=0.007). SEP were implanted in 149 patients (49 patients with rEF), while BEP were implanted in 538 patients (92 patients with rEF). All-cause 1-year mortality was similar after SEP- and BEP-implantation (16% vs 19%, p=0.516) in patients with pEF. In patients with rEF, however, 1-year mortality was higher after SEP- than after BEP-implantation (43% vs. 21%, p=0.004, see figure). Patients with rEF had a higher incidence of new permanent pacemaker implantation (26.5% vs. 13%, p=0.046) and paravalvular leak =2 (21% vs. 10%, p=0.07) after SEP- than after BEP-implantation, but both factors could not explain the excess mortality after SEP-implantation in multivariate analysis.

Conclusion: Patients with rEF had a higher 30-day and 1-year mortality after TF-TAVI when a SEP instead of a BEP was used. Further studies are needed to confirm and explain this finding.



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