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. 2019 Nov 26;14(11):e0225473.
doi: 10.1371/journal.pone.0225473. eCollection 2019.

Outcome of patients with heart failure after transcatheter aortic valve implantation

Ulrich Fischer-Rasokat  1   2 , Matthias Renker  1   3   4 , Christoph Liebetrau  1   2   4 , Maren Weferling  1 , Andreas Rolf  1   2   4 , Mirko Doss  3 , Helge Möllmann  5 , Thomas Walther  3   4   6 , Christian W Hamm  1   2   4 , Won-Keun Kim  1   2   3
Affiliations

Outcome of patients with heart failure after transcatheter aortic valve implantation

Ulrich Fischer-Rasokat et al. PLoS One. .

Abstract

Aims: Patients with aortic stenosis (AS) may have concomitant heart failure (HF) that determines prognosis despite successful transcatheter aortic valve implantation (TAVI). We compared outcomes of TAVI patients with low stroke volume index (SVI) ≤35 ml/m2 body surface area in different HF classes.

Methods and results: Patients treated by transfemoral TAVI at our center (n = 1822) were classified as 1) 'HF with preserved ejection fraction (EF)' (HFpEF, EF ≥50%), 2) 'HF with mid-range EF' (HFmrEF, EF 40-49%), or 3) 'HF with reduced EF' (HFrEF, EF <40%). Patients with SVI >35 ml/m2 served as controls. The prevalence of cardiovascular disease and symptoms increased stepwise from controls (n = 968) to patients with HFpEF (n = 591), HFmrEF (n = 97), and HFrEF (n = 166). Mortality tended to be highest in HFrEF patients 30 days post-procedure, and it became significant after one year: 10.2% (controls), 13.5% (HFpEF), 13.4% (HFmrEF), and 23.5% (HFrEF). However, symptomatic improvement in survivors of all groups was achieved in the majority of patients without differences among groups.

Conclusions: Patients with AS and HF benefit from TAVI with respect to symptom alleviation. TAVI in patients with HFpEF and HFmrEF led to an identical, favorable post-procedural prognosis that was significantly better than that of patients with HFrEF, which remains a high-risk population.

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Conflict of interest statement

Matthias Renker: speaker fees from St. Jude Medical/Abbott, Christoph Liebetrau: speaker fees from Abbott, Mirko Doss: proctor fees for Boston-Scientific, Helge Möllmann: proctor/speaker fees from Abbott, Biotronik, Edwards Lifesciences, St. Jude Medical, Boston-Scientific, Christian W. Hamm: advisory board Medtronic, Won-Keun Kim: proctor/speaker fees from Boston-Scientific, St. Jude Medical, Edwards Lifesciences This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow chart illustrating the four groups derived from the entire patient population.
AS = aortic stenosis; AVA = aortic valve area; AVAi = AVA index; BSA = body surface area; MPG = mean pressure gradient; SV = stroke volume; LVEF = left ventricular ejection fraction; HFpEF = heart failure with preserved ejection fraction; HFmrEF = heart failure with mid-range ejection fraction; HFrEF = heart failure with reduced ejection fraction; TF = transfemoral.
Fig 2
Fig 2. Change in NYHA functional status after TAVI.
Changes in NYHA functional status from the timepoint before TAVI to the 30-day follow-up. Values are total percentages within each individual group.
Fig 3
Fig 3. Survival curves based on all-cause mortality.
Kaplan-Meier analysis of all-cause mortality of control patients and patients with HFpEF (heart failure with preserved ejection fraction), HFmrEF (heart failure with mid-range ejection fraction) and HFrEF (heart failure with reduced ejection fraction).
See this image and copyright information in PMC

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