D. M. Strauss1, A. Das1, G. Savulionyte1, K. J. Oh1, N. L. Owen-Simon1, H. A. Cohen1, B. O’Murchu1, B. P. O’Neill1, G. Wheatley1 1Temple University,Philadelpha, PA, USA
Introduction: Transcatheter aortic valve replacement (TAVR) has been shown to have improved outcomes compared to surgical aortic valve replacement in high surgical risk patients with aortic stenosis. However, depressed left ventricular ejection fraction (LVEF) has been shown to be a relative contraindication to TAVR in these patients. The purpose of this study is to compare the outcomes of patients with decreased LVEF versus patients with normal LVEF.
Methods: A retrospective review of patients undergoing TAVR from December 2013 to June 2015 was performed. Institutional Review Board approval was obtained. Demographic information and outcome data were collected regarding LVEF, procedural success, and lengths of stay in the intensive care unit and hospital. Statistical analysis was performed using SPSS Statistics.
Results: Forty-two patients (5 Low LVEF, 37 High LVEF) underwent TAVR from December 2013 to June 2015. Average age for low LVEF patients was 70.6 years and 79.8 years for high LVEF patients (p=0.22). M:F ratio was 1:4 for low LVEF patients, and 12:25 for high LVEF patients (p=0.57). Average Society of Thoracic Surgeons (STS) score for low LVEF patients was 8.5, and 9.4 for high LVEF patients (p=0.32). [Figure 1] Four (80%) patients in the low LVEF group had a diagnosis of chronic obstructive pulmonary disease (COPD), and 19 (51.4%) patients in the high LVEF group had COPD (p=0.23). The Medtronic CoreValve was used in 3 patients with low preoperative LVEF and 12 patients with high LVEF (p=0.23), while the Edward SAPIEN prosthesis was implanted in 2 patients with low LVEF and 25 patients with high LVEF. Procedural success was 100% in both groups. Operative times averaged 125.4 (84-162) minutes in the low LVEF group and 124.0 (60-207) minutes in the high LVEF group (p=0.94). Four low LVEF patients (80%) were extubated in the operating room, while 29 (78.4%) high LVEF patients extubated in the operating room (p=0.94). Average intensive care unit stay (ICU) was 2.0 (1-3) days for low LVEF patients and 2.8 (0-12) days for high LVEF patients (p=0.14). Average hospital stay for low LVEF patients was 6.6 (3-9) days and 6.1 (2-28) days for high LVEF patients (p=0.75). 30-day mortality was 0 in low LVEF group and 5.4% (n=2) in the high LVEF group (p=0.059).
Conclusion: Patients with low LVEF undergoing TVR had comparable outcomes and length of hospital stay as compared to patients with high LVEF. As a result, low LVEF should not be used as an exclusion criteria for patient selection for TAVR. Additional studies are needed to evaluate long term outcomes and quality of life indicators.
