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Opportunity or futility? TAVI in elderly patients with depressed ejection fraction and severe aortic stenosis.

Session Poster Session 3

Speaker Jose Maria Vieitez Florez

Congress : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease - Treatment
  • Session type : Poster Session
  • FP Number : P1798

Authors : JM Vietez Florez (Madrid,ES), G Alonso Salinas (Madrid,ES), L Salido Tahoces (Madrid,ES), M Abellas Sequeiros (Madrid,ES), A Lorente Ros (Madrid,ES), R Garcia (Madrid,ES), JL Mestre Barcelo (Madrid,ES), S Del Prado Diaz (Madrid,ES), A Pardo (Madrid,ES), R Hernandez Antolin (Madrid,ES), JL Zamorano (Madrid,ES)

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Authors:
JM Vietez Florez1 , G Alonso Salinas1 , L Salido Tahoces1 , M Abellas Sequeiros1 , A Lorente Ros1 , R Garcia1 , JL Mestre Barcelo1 , S Del Prado Diaz1 , A Pardo1 , R Hernandez Antolin1 , JL Zamorano1 , 1University Hospital Ramon y Cajal de Madrid, Cardiology - Madrid - Spain ,

Citation:

Introduction:
TAVI has become the election treatment in elderly patients with symptomatic severe aortic stenosis (AS) and medium or high surgical risk. However, whether if  TAVI is a good option for this population presenting also reduced left ventricular ejection fraction (LVEF) is still unknown. Is TAVI safe in these patients?

Methods:
Patients with severe AS who TAVI was implanted were prospectively assessed between 2010-2018. Patients with reduce LVEF (=40%) were compared against patients with preserved function. Clinical and echocardiographic characteristics at baseline were recorded. All TAVI complications were collected. During follow up clinical and  echocardiographic data, hospitalizations and mortality were recorded. Patients without LVEF quantification previous to TAVI were excluded..

Results:
A total of 301 patients were finally included. 85,71% (n=258) has preserved(=50%) and 7,97% (24) patients have a reduced LVEF (=40%). 6,31% (19) has a LVEF between 40% and 50%. The average follow-up was 16,55 months. Total mortality was 8,39%, and 35,65% patients had a rehospitalisation.

Patients with reduced LVEF were mostly men (75%), with statically significant higher BNP values (1246 vs. 421, p<0,01), worst right ventricle function (TAPSE 15,01 mm vs. 19,42 mm, p<0.02) and more prevalence of low flow-low gradient AS (mean gradient 28,7 mmHg vs. 43,86 mmHg, p<0,01).  There were no other differences in baseline characteristics between both groups (Table 1).

There were no differences in intraprocedure complications neither hospitalization days after TAVI (7,55 vs. 5,44 p=0,11).

During the follow up there were no differences in mortality (8,33% vs. 11,24%, p=0,189), rehospitalisation events (16,67% vs. 32,87%, p=0,155) or in the composed endpoint of admissions or mortality (21.05% vs. 38,96%, p=0,121) between reduced and preserved LVEF group.

Conclusions:
TAVI in elderly patients with depressed LVEF (=40%) is a safe procedure with similar outcomes  than patients with preserved LVEF.  These data should be confirmed in larger and longer registries.

FEVI 40% (n=24)

FEVI 50% (n=258)

P

Age (years)

82.59; 9.44

83.92; 6.03

0.33

Women

6; 25%

173; 67.05%

< 0.01

Pre Cr (g/dl)

1.54; 5.86

1.17; 0.36

0.7573

Pre Euroscore2

7.33; 6.43

4.06; 11.27

0.2534

Pre medium pressure gradient (mmHg)

28.7; 8.56

43.86; 14.72

<0.01

Pre aortic area

0.71; 0.17

0.72; 0.18

0.8007

Baseline characteristics

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