title: Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation.
abstract: BACKGROUND
  Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction (LVEF) on mortality after TAVI.
  
  
  METHODS
  Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF ≤ 30% on mortality was assessed by Cox regression.
  
  
  RESULTS
  Patients with LVEF ≤ 30% (n = 63), as compared to those with LVEF > 30% (n = 586), had a higher prevalence of NHYA class > 2 (P < 0.001) and presented with a higher Euroscore (P < 0.001). Procedural success was similar in both groups (98.4% vs. 97.2%, P = 1). After a median follow-up of 436 days (25(th)-75(th) percentile, 357-737 days), all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios (HR): 0.96, 95% confidence intervals (CI): 0.56-1.63] and cardiac mortality (19.1% vs. 17.6%, P = 0.89, HR: 1.04, 95% CI: 0.57-1.90) were similar in patients with LVEF ≤ 30% as compared to those with LVEF > 30%. Thirty-day all-cause mortality was not significantly different between the two groups (11.1% vs. 6.3%, P = 0.14, HR: 1.81, 95% CI: 0.81-4.06). Patients with LVEF ≤ 30% had a trend toward higher risk of 30-day cardiac mortality (11.1% vs. 5.3%; P = 0.06, HR: 2.16, 95% CI: 0.95-4.90), which disappeared after multivariable adjustment (P = 0.22).
  
  
  CONCLUSIONS
  Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.
authors.affiliation: Department of Cardiovascular Medicine, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.affiliation: Department of Cardiovascular Medicine, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.affiliation: Department of Cardiovascular Medicine, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pagnotta
authors.affiliation: Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Sonia Petronio
authors.affiliation: Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy.
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.affiliation: Department of Interventional Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.affiliation: Cardiothoracic Department, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.affiliation: Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.affiliation: Cardiothoracic Department, Ospedale Molinette, Torino, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Department of Interventional Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.affiliation: Department of Cardiovascular Medicine, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Marco L
authors.initials: ML
authors.lastname: Rossi
authors.affiliation: Cardiothoracic Department, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.affiliation: Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
keywords: Left ventricular ejection fraction; Mortality; Transcatheter aortic valve implantation