Impact of right and left ventricular systolic dysfunction on perioperative outcome and long-term survival after transcatheter aortic valve replacement.

Abstract

BACKGROUND:

Aim of the study was to determine the impact of right- and left-ventricular systolic dysfunction on perioperative outcome and long-term survival after TAVR.

METHODS:

Study population consisted of 702 TAVRs between 2009 and 2014, 345 by TF, 357 by TA route. RV and LV function were determined by TAPSE and LVEF measurement during baseline echocardiography. Patients were divided according to TAPSE (>18 mm/14-18 mm/<14 mm) and LVEF (>50%/30-50%/<30%) tertiles. Outcome at day-30 and Kaplan-Meier 4-year survival were analyzed.

RESULTS:

Impaired RV and LV-function did not adversely affect mortality, stroke, bleeding, and vascular-complications at 30 days. Patients with TAPSE < 14 mm displayed elevated rate of renal failure requiring dialysis (11%; P < 0.01). Kaplan-Meier survival was adversely affected by RV-systolic dysfunction RVSD (P < 0.01). Multivariate analysis revealed that impaired RVSD but not LVSD was an independent determinant for late mortality (hazard ratio TAPSE 14-18 mm: 1.53; P = 0.02; TAPSE <14 mm: 2.12; P < 0.01).

CONCLUSIONS:

Peri-operative mortality and risk of stroke after TAVR are not adversely affected by preexisting RV or LV dysfunction. Long-term survival is impaired in patients with RVSD. RVSD but not LVSD is an independent risk factor for late mortality. TAVR should be the preferred therapy for patients with RVSD and LVSD, especially when patient is suitable for TF.

• Authors: Daniel P Griese, Sebastian Kerber, Sebastian Barth, Anno Diegeler, Jörg Babin-Ebell, Wilko Reents
• Journal: Journal of interventional cardiology (J Interv Cardiol) Vol. 30 Issue 3 Pg. 217-225 (Jun 2017) ISSN: 1540-8183 [Electronic] United States
• PMID: 28439917 (Publication Type: Journal Article)
• Copyright: © 2017, Wiley Periodicals, Inc.

Topics

• Aged
• Aortic Valve (physiopathology, surgery)
• Aortic Valve Stenosis (diagnosis, mortality, physiopathology, surgery)
• Echocardiography (methods)
• Female
• Germany (epidemiology)
• Humans
• Kaplan-Meier Estimate
• Long Term Adverse Effects (mortality)
• Male
• Proportional Hazards Models
• Risk Factors
• Severity of Illness Index
• Statistics as Topic
• Transcatheter Aortic Valve Replacement (adverse effects, methods, mortality)
• Treatment Outcome
• Ventricular Dysfunction (diagnosis, physiopathology)