Influence of baseline ejection fraction on the prognostic value of paravalvular leak after transcatheter aortic valve implantation.
BACKGROUND
Moderate or severe paravalvular leak (PVL ≥ moderate) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. The aim of this study was to assess whether the baseline ejection fraction (EF) affects the impact of PVL on mortality after TAVI.


METHODS
We analyzed 514 consecutive patients with native severe aortic stenosis who underwent TAVI. Patients were divided into two groups: EF < 40% group (n = 84) and EF ≥ 40% group (n = 430) according to baseline EF.


RESULTS
The mean age was 79.5 years and 49% were male. Patients in the EF < 40% group were younger and with higher logistic EuroSCORE compared to patients in the EF ≥ 40% group. Diabetes, coronary artery disease, atrial fibrillation and renal insufficiency were more prevalent in the EF < 40% group. Patients in the EF <40% group had more mitral regurgitation. In-hospital mortality was significantly higher in the EF < 40% group (8.3% vs. 0.9%, p < 0.0001). PVL ≥ moderate was significantly associated with increased 2-year estimated mortality only in the EF <40% group (65% vs. 20%, log-rank p < 0.0001) whereas no difference was seen in the EF ≥40% group (24% vs. 19%, log-rank p = 0.509). Interaction between PVL ≥ moderate and EF < 40% was statistically significant.


CONCLUSIONS
The impact of PVL ≥ moderate on mortality after TAVI was significant in the EF <40% group but not in the EF ≥ 40% group in our study. Even though operators should aim to minimize PVL in all TAVI patients, special attention is required for patients with reduced baseline EF.
Division of Noninvasive Cardiology, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132 Milan, Italy; Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, 1138421 Tokyo, Japan.
Sakiko
S
Miyazaki
Division of Noninvasive Cardiology, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132 Milan, Italy. Electronic address: agricola.eustachio@hsr.it.
Eustachio
E
Agricola
Interventional Cardiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy; National Heart and Lung Institute, Imperial College London, SW7 2AZ London, United Kingdom.
Vasileios F
VF
Panoulas
Division of Noninvasive Cardiology, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132 Milan, Italy.
Massimo
M
Slavich
Interventional Cardiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
Gennaro
G
Giustino
Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, 1138421 Tokyo, Japan; Interventional Cardiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
Tadashi
T
Miyazaki
Interventional Cardiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
Filippo
F
Figini
Interventional Cardiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
Azeem
A
Latib
Interventional Cardiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
Alaide
A
Chieffo
Interventional Cardiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
Matteo
M
Montorfano
Division of Noninvasive Cardiology, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132 Milan, Italy.
Alberto
A
Margonato
Cardiac Surgery Department, Zurich University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland; Department of Cardiac Surgery, San Raffaele Hospital, IRCCS, Milan, Italy.
Francesco
F
Maisano
Department of Cardiac Surgery, San Raffaele Hospital, IRCCS, Milan, Italy.
Ottavio
O
Alfieri
Interventional Cardiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
Antonio
A
Colombo
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D065467:Transcatheter Aortic Valve Replacement / Q000639:trends*; D014463:Ultrasonography
2-Year mortality; Aortic stenosis; Left ventricular ejection fraction; Paravalvular leak; Transcatheter aortic valve implantation