Outcomes among patients with heart failure with reduced ejection fraction undergoing transcatheter aortic valve replacement: Minimally invasive strategy versus conventional strategy.

Outcomes among patients with heart failure with reduced ejection fraction undergoing transcatheter aortic valve replacement: Minimally invasive strategy versus conventional strategy.

Panhwar MS; Li J; Zidar DA; Clevenger J; Lipinski J; Patel TR; Karim A; Saric P; Patel SM; Kalra A; Attizzani GF

The Journal of invasive cardiology

2019

2019-03

OBJECTIVES: To investigate the effect of TAVR technique on in-hospital and 30-day outcomes in patients with aortic stenosis (AS) and reduced ejection fraction (EF). BACKGROUND: Patients with AS and concomitant low EF may be at risk for adverse hemodynamic effects from general anesthesia utilized in transcatheter aortic valve replacement (TAVR) via the conventional strategy (CS). These patients may be better suited for the minimally invasive strategy (MIS), which employs conscious sedation. However, data are lacking that compare MIS to CS in patients with AS and concomitant low EF. METHODS: In this retrospective study, we identified all patients with low EF (<50%) undergoing transfemoral MIS-TAVR vs CS-TAVR between March 2011 and May 2018. Our primary endpoint was defined as the composite of in-hospital mortality and major periprocedural bleeding or vascular complications. RESULTS: Two hundred and seventy patients had EF <50%, while 154 patients had EF ≤35%. Overall, a total of 236 patients were in the MIS group and 34 were in the CS group. Baseline characteristics between the two groups were similar except for Society of Thoracic Surgeons (STS) score (MIS 8.4 ± 5.1 vs CS 11.7 ± 6.8; P<.01). There were no differences between the two groups in incidence of the primary endpoint (MIS 5.5% vs CS 8.8%; odds ratio for MIS, 0.60; 95% confidence interval, 0.16-2.23; P=.45). CONCLUSIONS: In patients with severe AS and reduced EF, MIS was not associated with adverse in-hospital or 30-day clinical outcomes compared with CS. In these patients, MIS may be a suitable alternative to CS without compromising clinical outcomes.

Female; Humans; Male; Aged; Retrospective Studies; Treatment Outcome; Prognosis; Cohort Studies; Severity of Illness Index; Aged 80 and over; Logistic Models; Survival Rate; Length of Stay; Multivariate Analysis; Risk Assessment; Reference Values; Hospital Mortality; aortic stenosis; transcatheter aortic valve replacement; heart failure; Transcatheter Aortic Valve Replacement/methods/mortality; anesthesia; conscious sedation; Aortic Valve Stenosis/diagnostic imaging/epidemiology/therapy; Cardiac Catheterization/methods; Cardiac Output Low/diagnostic imaging; Conscious Sedation/methods; Echocardiography Transesophageal/methods; Heart Failure/diagnosis/epidemiology/therapy; Minimally Invasive Surgical Procedures/methods; Surgery Computer-Assisted/methods

PMID: 30555054

Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

journalArticle

15-20

3

31

1557-2501

NEOMED College of Medicine

Department of Internal Medicine

June2020SubmittedList

Cleveland Clinic Akron General Hospital