title: Transcatheter aortic valve implantation in patients with severely reduced left ventricular systolic function: a single-center experience.
abstract: OBJECTIVE
  Current guidelines consider severe systolic left ventricular dysfunction [ejection fraction (EF) ≤20 %; left ventricular dysfunction (LVD)] a contraindication for transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the efficacy and safety of TAVI in this extreme risk subset of patients.
  
  
  RESULTS
  The study population (253 patients) was divided into two groups; the LVD group [21 patients with left ventricular ejection fraction (LVEF) ≤20 %] and the control group (232 patients with LVEF >20 %). TAVI was generally performed transfemorally under analgosedation without mechanical circulatory support. Clinical and hemodynamic variables, as well as procedural and follow-up outcomes, were compared, and all events were defined according to the Valve Academic Research Consortium criteria for event definition. Mean EF in the LVD group was 18.3 ± 2.9 % compared to 50.9 ± 11.3 % in the control group. Patients in the LVD group were younger, more commonly males, had higher logistic EuroSCORE and lower mean aortic pressure gradients. Immediate procedural mortality was low and similar in both groups (0 vs. 2.2 % in the LVD and control group, respectively, p = 0.49). At 30 days, post-procedural vascular and bleeding complications as well as strokes were similar, but all-cause mortality was higher in the LVD group (14.3 vs. 3.4 %, p = 0.05). In the survivors of the LVD group, New York Heart Association functional class and LVEF significantly improved at 30 days and 6 months. Survival at 1 and 2 years was 70.2 vs. 86.0 % and 56.1 vs. 78.3 % in the LVD and control group, respectively (log-rank p = 0.03).
  
  
  CONCLUSIONS
  TAVI without mechanical circulatory support appears feasible, safe and effective in patients with severe aortic stenosis and severe LVD, but short- and long-term mortality remain high. TAVI should be considered a viable treatment option in this subset of extremely compromised patients.
authors.affiliation: Department of Cardiology, Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany, mohamed.elmawardy@segebergerkliniken.de.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Mawardy
authors.forename: Nora
authors.initials: N
authors.lastname: Wübken-Kleinfeld
authors.forename: Bettina
authors.initials: B
authors.lastname: Schwarz
authors.forename: Ken
authors.initials: K
authors.lastname: Gordian
authors.forename: Björn
authors.initials: B
authors.lastname: Stöcker
authors.forename: Holger
authors.initials: H
authors.lastname: Sier
authors.forename: Ralph
authors.initials: R
authors.lastname: Toelg
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.forename: Ernst-Günther
authors.initials: EG
authors.lastname: Kraatz
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology*