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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
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)
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K El Chilali1
1University Hospital of Essen, West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine - Essen - Germany
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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