title: Patients with severe aortic stenosis and reduced ejection fraction: earlier recovery of left ventricular systolic function after transcatheter aortic valve implantation compared with surgical valve replacement.
abstract: BACKGROUND
  Only 50% of patients with aortic stenosis (AS) and low ejection fraction (EF) improve their contractility after surgical aortic valve replacement (AVR). Long-term prognosis of these patients is strongly correlated to EF recovery after the surgery. The aim of this study was to compare the postoperative left ventricular function recovery in patients with severe AS and reduced EF after AVR and transcatheter aortic valve implantation (TAVI).
  
  
  RESULTS
  Twenty-one patients undergoing AVR for severe AS (<1 cm²) and reduced EF (<45%) were echocardiographically compared with 31 patients treated with TAVI by conventional and two-dimensional (2D) strain method. TAVI patients were older (83 ± 6 vs. 74 ± 13 years, P < 0.001), had more comorbidities (Euroscore 26 ± 15% vs. 16 ± 12%, P < 0.001) and no differences in ischemic heart disease (16.1% vs. 9.5%, P = 0.39). EF was similar in both groups at baseline. Aortic valve area significantly increased (P = 0.01) while pressure gradient decreased (P = 0.009) after both procedures but TAVI was associated with a better EF recovery compared with AVR at day 7. Regional function assessed by radial 2D strain increased in TAVI group but was transiently deteriorated in AVR patients (P < 0.05). Longitudinal as well as circumferential 2D strain progressively increased at follow-up in both groups (P < 0.05). EF was similar in both groups at 3-month follow-up.
  
  
  CONCLUSIONS
  In patients with severe AS and reduced EF, TAVI is associated with faster and better recovery of LV function compared with AVR.
authors.affiliation: Department of Cardiology and Cardiac Surgery, Rouen University Hospital, Rouen, France; Unité INSERM U1096, Rouen University Medical School, Rouen, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bauer
authors.forename: Véronique
authors.initials: V
authors.lastname: Coutant
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bernard
authors.forename: Dimitri
authors.initials: D
authors.lastname: Stepowski
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Bessou
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*
keywords: aortic stenosis; aortic valve surgery; left ventricular function; prognosis; transcatheter valve implantation