Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction: A single centre pilot study

Joud Al Balool; Mohammed Al Jarallah; Rajesh Rajan; Raja Dashti; Nader Alasousi; Vladimir Kotevski; Ahmed Said Taha Mousa; Retaj Al Haroun; Gary Tse; Kobalava D Zhanna; Parul Setiya; Ahmad Al Saber; Peter A Brady

doi:10.1016/j.amsu.2022.103712

Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction: A single centre pilot study

Ann Med Surg (Lond). 2022 May 7:77:103712. doi: 10.1016/j.amsu.2022.103712. eCollection 2022 May.

Authors

Affiliations

¹ Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
² Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait.
³ Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
⁴ Department of Medicine, Royal College of Surgeons, Dublin, Ireland.
⁵ Cardiovascular Analytics Group, Hong Kong, China: Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
⁶ Department of Agrometeorology, College of Agriculture, G.B.Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India.
⁷ Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, UK.
⁸ Department of Cardiology, Illinois Masonic Medical Center, Chicago IL, USA.

Abstract

Introduction: To define baseline echocardiographic, electrocardiographic (ECG) and computed tomographic (CT) findings of patients with heart failure undergoing transcatheter aortic valve replacement (TAVR) and analyze their overall procedural outcomes.

Methods: Between 2018 and 2021, patients with severe aortic stenosis (AS) who performed transcatheter aortic valve replacement (TAVR) in Sabah Al Ahmad Cardiac Centre, Al Amiri Hospital were identified. A retrospective review of patients' parameters including pre-, intra-, and post-procedural data was conducted. Patients were grouped in 2 subgroups according to their EF: EF <40% (HFrEF) and EF ≥ 40%. The data included patients' baseline characteristics, electrocardiographic and echocardiographic details along with pre-procedural CT assessment of aortic valve dimensions. Primary outcomes including post-operative disturbances, pacemaker implantation and in-hospital mortality following TAVR were additionally analyzed.

Results: A total of 61 patients with severe AS underwent TAVR. The mean age was 73.5 ± 9, and 21 (34%) of the patients were males. The mean ejection fraction (EF) was 55.5 ± 9.7%. Of 61 patients, 12 (20%) were identified as heart failure with reduced EF (<40%). These patients were younger, more often males, and were more likely to have coronary artery disease (75% versus 53.1%). Left ventricular hypertrophy and diastolic dysfunction was documented in 75% and 58.3% of patients with heart failure with reduced ejection fraction (HFrEF) respectively. Post TAVR conduction disturbances, with the commonest being LBBB was observed in 41.7%. Permanent pacemaker was implanted in 3 of patients with HFrEF (25%). There were no significant differences between the two groups with regards to in hospital mortality (p = 0.618).

Conclusion: Severe AS with EF <40% constitute a remarkable proportion of patients undergoing TAVR. Preliminary results of post-operative conduction disturbances and in hospital mortality in HFrEF patients were concluded to not differ from patients with LVEF ≥40%.

Keywords: AV block; LVEF; TAVI.