title: Impact of left ventricular function and transaortic gradient on outcomes from transcatheter aortic valve implantation: data from the UK TAVI Registry.
abstract: OBJECTIVE
  Aortic valve surgery in the presence of reduced ejection fraction (EF) or low transaortic gradient is associated with adverse outcome. Low gradient (LG) may be associated with reduced EF, known as low EF-low gradient (LEF-LG), or "paradoxically" low with normal EF (P-LG). Our aim was to investigate the impact of EF and transaortic gradient on outcome following transcatheter aortic valve implantation (TAVI).
  
  
  RESULTS
  We retrospectively analysed the UK TAVI Registry from 2007 to 2011 (n=2,535 consecutive patients, mean age 81.3±7.5, logistic EuroSCORE 21.8±14). Thirty-day mortality was 7.8%, low EF (<50%) was present in 39%, low gradient (<64 mmHg) was present in 27%, LEF-LG in 15% and P-LG in 12% of patients, respectively. LEF-LG patients had the highest risk profile vs. the other groups (EuroSCORE 30±16 vs. 20±12, p<0.001). Neither EF nor gradient impacted on procedural outcome or 30-day mortality. Mortality at two years was significantly higher in LEF-LG patients (34.7%), whereas, in patients with low EF/high gradient (27.8%) or normal EF/low gradient (23%), mortality was not significantly different from that of normal EF/high gradient (23%) patients. LEF-LG independently predicted reduced survival, HR 1.7 (1.4-2.1).
  
  
  CONCLUSIONS
  Neither low EF nor low gradient affected procedural success or 30-day mortality. Long-term survival was reduced in LEF-LG patients but not in those with low EF and high gradient or P-LG with normal EF.
authors.affiliation: Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Malkin
authors.forename: W Robert
authors.initials: WR
authors.lastname: Long
authors.forename: Paul D
authors.initials: PD
authors.lastname: Baxter
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Gale
authors.forename: Olaf
authors.initials: O
authors.lastname: Wendler
authors.forename: Mark
authors.initials: M
authors.lastname: Monaghan
authors.forename: Martyn T
authors.initials: MT
authors.lastname: Thomas
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Cunningham
authors.forename: Neil E
authors.initials: NE
authors.lastname: Moat
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D013318:Stroke Volume; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*