Impact of Changes in Left Ventricular Ejection Fraction on Survival After Transapical Aortic Valve Implantation.
BACKGROUND
This single-center retrospective study assessed the variation of left ventricular ejection fraction (LVEF) after transapical transcatheter aortic valve implantation and its effect on survival. We also evaluated the effect of sheath diameter on LVEF.


METHODS
We analyzed data of all consecutive patients who underwent transapical transcatheter aortic valve implantation with the Sapien (Edwards Lifesciences, Irvine, CA) device (and its evolutions) between 2009 and 2015. We analyzed the difference between preoperative LVEF and LVEF at discharge (ΔEF = LVEFpost-op - LVEFpre-op) and considered its interquartile range (±5%) as the cutoff. Patients were divided in three groups: (1) improved LVEF (ΔEF ≥ +5%); (2) unchanged LVEF (ΔEF -5% to +5%), and (3) worsened LVEF (ΔEF ≤ -5%). Survival was evaluated with Kaplan-Meier analysis, and logistic regression multivariable analysis was used to determine independent predictors of LVEF improvement.


RESULTS
Data of 122 patients were analyzed. Patients in the three groups were distributed as follows: (group 1) 27 patients (22.1%), (group 2) 69 (56.6%), and (group 3) 26 (21.3%). The mean ΔEF was 12.7% ± 4.7% in group 1 and -10.8% ± 3.9% in group 3. The ΔEF was more likely to improve in patients with preoperative LVEF of less than 0.35 (p = 0.014). There were no significant differences in survival (p = 0.41), rehospitalization (p = 0.472), and New York Heart Association Functional Classification (p = 0.307) among the groups. The use of the smallest available sheath (18F) was not associated with a significant change of ΔEF.


CONCLUSIONS
LVEF worsened in a small number of patients after transapical transcatheter aortic valve implantation, but this change was not associated with worse postoperative outcomes. Patients with a low LVEF showed better improvement. The progressive reduction of sheath diameter does not have a significant effect on LVEF changes.
Division of Cardiac Surgery, University of Padova, Padova, Italy. Electronic address: adonofrio@hotmail.it.
Augusto
A
D'Onofrio
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Laura
L
Besola
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Giulio
G
Rizzoli
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Eleonora
E
Bizzotto
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Erica
E
Manzan
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Chiara
C
Tessari
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Roberto
R
Bianco
Division of Cardiology, University of Padova, Padova, Italy.
Giuseppe
G
Tarantini
Division of Cardiology, University of Padova, Padova, Italy.
Luigi P
LP
Badano
Division of Cardiology, University of Padova, Padova, Italy.
Massimo
M
Napodano
Division of Cardiology, University of Padova, Padova, Italy.
Chiara
C
Fraccaro
Division of Anesthesiology, University of Padova, Padova, Italy.
Demetrio
D
Pittarello
Division of Cardiac Surgery, University of Padova, Padova, Italy.
Gino
G
Gerosa
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*