Document Detail


Comparison between transcatheter and surgical prosthetic valve implantation in patients with severe aortic stenosis and reduced left ventricular ejection fraction.
MedLine Citation:
PMID:  20975002     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis with conservative therapy but a high operative mortality when treated surgically. Recently, transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement (SAVR) for patients considered at high or prohibitive operative risk. The objective of this study was to compare TAVI and SAVR with respect to postoperative recovery of LVEF in patients with severe aortic stenosis and reduced LV systolic function.
METHODS AND RESULTS: Echocardiographic data were prospectively collected before and after the procedure in 200 patients undergoing SAVR and 83 patients undergoing TAVI for severe aortic stenosis (aortic valve area ≤1 cm(2)) with reduced LV systolic function (LVEF ≤50%). TAVI patients were significantly older (81±8 versus 70±10 years; P<0.0001) and had more comorbidities compared with SAVR patients. Despite similar baseline LVEF (34±11% versus 34±10%), TAVI patients had better recovery of LVEF compared with SAVR patients (ΔLVEF, 14±15% versus 7±11%; P=0.005). At the 1-year follow-up, 58% of TAVI patients had a normalization of LVEF (>50%) as opposed to 20% in the SAVR group. On multivariable analysis, female gender (P=0.004), lower LVEF at baseline (P=0.005), absence of atrial fibrillation (P=0.01), TAVI (P=0.007), and larger increase in aortic valve area after the procedure (P=0.01) were independently associated with better recovery of LVEF.
CONCLUSION: In patients with severe aortic stenosis and depressed LV systolic function, TAVI is associated with better LVEF recovery compared with SAVR. TAVI may provide an interesting alternative to SAVR in patients with depressed LV systolic function considered at high surgical risk.
Authors:
M A Clavel; J G Webb; J Rodés-Cabau; J B Masson; E Dumont; R De Larochellière; D Doyle; S Bergeron; H Baumgartner; I G Burwash; J G Dumesnil; G Mundigler; R Moss; A Kempny; R Bagur; J Bergler-Klein; R Gurvitch; P Mathieu; P Pibarot
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-25
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-09     Completed Date:  2010-12-23     Revised Date:  2011-09-27    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1928-36     Citation Subset:  AIM; IM    
Affiliation:
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve / transplantation
Aortic Valve Stenosis / mortality,  physiopathology,  surgery*,  ultrasonography
Atrial Fibrillation / mortality,  physiopathology,  surgery,  ultrasonography
Bioprosthesis
Echocardiography / methods
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / methods*,  mortality
Humans
Male
Middle Aged
Mitral Valve Insufficiency / mortality,  physiopathology,  surgery,  ultrasonography
Myocardial Infarction / complications,  epidemiology
Sex Characteristics
Stroke / epidemiology,  mortality
Stroke Volume / physiology*
Treatment Outcome
Ventricular Function, Left / physiology
Grant Support
ID/Acronym/Agency:
57445//Canadian Institutes of Health Research
Comments/Corrections
Comment In:
Circulation. 2011 Aug 16;124(7):e205; author reply e207-8   [PMID:  21844085 ]
Nat Rev Cardiol. 2011 Jan;8(1):6   [PMID:  21218560 ]
Circulation. 2011 Aug 16;124(7):e206; author reply e207-8   [PMID:  21844086 ]

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