title: Transcatheter aortic valve implantation in patients with severe left ventricular dysfunction: immediate and mid-term results, a multicenter study.
abstract: BACKGROUND
  Few data exist about transcatheter aortic valve implantation (TAVI) in patients with low ejection fraction. The aim of the study was to analyze safety, feasibility, and efficacy of TAVI in patients with severe left ventricular dysfunction.
  
  
  RESULTS
  The study sample (384 patients) was divided into 2 groups: group A (50 patients) with left ventricular ejection fraction (LVEF) ≤35%, and group B (334 patients) with LVEF >35%. Clinical, anatomic, and hemodynamic variables, as well as procedural results and follow-up outcomes, were compared between the groups. Procedural success was reached in 88%, with no significant difference between the groups. The incidence of periprosthetic leak >2+/4 after TAVI was higher in group A. All other complications were similar between the 2 groups. Group A showed a significant and early improvement in LVEF (from 27.7±6.0-35.2±11.1 after TAVI; P<0.0001). Thirty-day mortality was 4%; however, this was higher in group A compared with group B (10% versus 3%; P=0.010). Predictors of the cumulative late mortality were congestive heart failure, logistic euroSCORE, and moderate-to-severe periprosthetic leakage after TAVI. Estimated survival by Kaplan Meier at 1 year was, respectively, 69% in group A and 87% in group B (log rank <0.0001).
  
  
  CONCLUSIONS
  Transcatheter aortic valve implantation is a safe and effective procedure, even in patients with severe left ventricular dysfunction, leading to a high procedural success rate with an acceptable rate of complications and 30-day mortality. Also in these critically ill patients, TAVI provides clinical amelioration, with early improvement in LVEF.
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy. chiara_fraccaro@hotmail.com
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.forename: Rasha
authors.initials: R
authors.lastname: Al-Lamee
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.forename: Giambattista
authors.initials: G
authors.lastname: Isabella
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D011475:Prosthesis Failure / Q000209:etiology; D020127:Recovery of Function; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*