title: Efficacy of transcatheter aortic valve implantation in patients with aortic stenosis and reduced LVEF. A systematic review.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is safe and effective for patients with aortic stenosis (AS) who have a high operative risk. However, there is still debate on the effect of TAVI in AS patients with reduced left ventricular ejection fraction (REF). The objective of the review is to clarify the efficacy of TAVI and the impact of REF on the 30-day and midterm mortality in these patients.
  
  
  METHODS
  Studies on TAVI were searched in PubMed, Embase, and the Cochrane Library databases and were included in this review following predefined criteria. Data were extracted and pooled risk ratios (RR) were synthesized to explore the relationship between REF and 30-day plus midterm mortality.
  
  
  RESULTS
  Twenty-eight studies comprising 14,099 patients were included in the analysis of the association of REF with the prognosis of patients after TAVI. An average increase in left ventricular ejection fraction of 8-10 % was observed among these patients after TAVI. REF was not related to the 30-day mortality [RR = 1.90, 95 % confidence interval (CI) = 0.80-4.47]; however, it was related to the midterm mortality (RR = 1.49, 95 %CI = 1.14-1.93) of patients undergoing TAVI. Patients with low-flow and low-gradient AS had a higher 30-day mortality (RR = 1.54, 95 %CI = 1.11-2.13) and midterm mortality rate (RR = 1.69, 95 %CI = 1.33-2.14) compared with AS patients without these characteristics. The mortality of TAVI patients was significantly lower than that of those undergoing conservative therapy, and was similar to that of patients undergoing surgical aortic valve replacement.
  
  
  CONCLUSIONS
  REF was not associated with 30-day mortality, but it was associated with the midterm mortality of TAVI patients. Patients with REF could benefit from TAVI compared with conservative therapy.
authors.affiliation: Department of Cardiology, West China Hospital of Sichuan University, No.37 Guo Xue Xiang of Wuhou District, 610041, Chengdu, Sichuan, P.R. China.
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: Z
authors.initials: Z
authors.lastname: Zhao
authors.forename: H
authors.initials: H
authors.lastname: Chai
authors.forename: C
authors.initials: C
authors.lastname: Zhang
authors.forename: Y
authors.initials: Y
authors.lastname: Liao
authors.forename: Q
authors.initials: Q
authors.lastname: Li
authors.forename: Y
authors.initials: Y
authors.lastname: Peng
authors.forename: W
authors.initials: W
authors.lastname: Liu
authors.forename: X
authors.initials: X
authors.lastname: Ren
authors.forename: Q
authors.initials: Q
authors.lastname: Meng
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.forename: Y
authors.initials: Y
authors.lastname: Feng
authors.forename: D
authors.initials: D
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*