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Clinical Trial
. 2022 Dec 18;17(1):322.
doi: 10.1186/s13019-022-02061-9.

Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction

Maina P Jalava  1 , Mikko Savontaus  2 , Tuomas Ahvenvaara  3 , Teemu Laakso  4 , Marko Virtanen  5 , Matti Niemelä  6 , Tuomas Tauriainen  3 , Pasi Maaranen  5 , Annastiina Husso  7 , Eve Kinnunen  4 , Sebastian Dahlbacka  4 , Jussi Jaakkola  2 , Stefano Rosato  8 , Paola D'Errigo  8 , Mika Laine  4 , Timo Mäkikallio  6 , Peter Raivio  4 , Markku Eskola  5 , Antti Valtola  7 , Tatu Juvonen  3   4 , Fausto Biancari  9 , Juhani Airaksinen  2 , Vesa Anttila  2
Affiliations
Clinical Trial

Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction

Maina P Jalava et al. J Cardiothorac Surg. .

Abstract

Background: Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis.

Methods: The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction.

Results: Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067-1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929-1.080, p = 0.964), respectively.

Conclusions: Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention. Trial registration The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.

Keywords: Aortic stenosis, AS; Heart failure; Left ventricular dysfunction; Left ventricular ejection fraction; Surgical aortic valve replacement, SAVR; Transcatheter aortic valve replacement, TAVR.

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Conflict of interest statement

MPJ, received grants from the Department of Clinical Medicine University of Turku, the Finnish Foundation for Cardiovascular Research and the Finnish Cultural Foundation; MS, is proctor for Medtronic, relationship is significant; TA, none; TL, none; MV, none; MN, none; TT, none; PM, none; AH, none; EK, none; SD, none; JJ, none; SR, none; PDE, none; ML, none; TM, none; PR, none; ME, none; AV, none; TJ, none; FB, none; JA, none; VA, none.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Survival of propensity score matched patients with severe aortic stenosis and reduced left ventricular ejection fraction after surgical and transcatheter aortic valve replacement
See this image and copyright information in PMC

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