Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction

Journal of Cardiothoracic Surgery

Research

Fausto Biancari¹  Timo Mäkikallio²  Matti Niemelä²  Tuomas Tauriainen³  Tuomas Ahvenvaara³  Tatu Juvonen⁴  Peter Raivio⁵  Mika Laine⁵  Eve Kinnunen⁵  Sebastian Dahlbacka⁵  Teemu Laakso⁵  Antti Valtola⁶  Annastiina Husso⁶  Jussi Jaakkola⁷  Maina P. Jalava⁷  Mikko Savontaus⁷  Vesa Anttila⁷  Juhani Airaksinen⁷  Marko Virtanen⁸  Markku Eskola⁸  Pasi Maaranen⁸  Stefano Rosato⁹  Paola D’Errigo⁹ 

[1] Clinica Montevergine, GVM Care and Research, Mercogliano, Italy;Department of Internal Medicine, Oulu University Hospital, Oulu, Finland;Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland;Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland;Heart Center, Helsinki University Hospital, Helsinki, Finland;Heart Center, Helsinki University Hospital, Helsinki, Finland;Heart Center, Kuopio University Hospital, Kuopio, Finland;Heart Centre, Turku University Hospital and University of Turku, P. O. Box 52, 20521, Turku, Finland;Heart Hospital, Tampere University Hospital and University of Tampere, Tampere, Finland;National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy;

关键词: Transcatheter aortic valve replacement, TAVR;    Surgical aortic valve replacement, SAVR;    Aortic stenosis, AS;    Left ventricular ejection fraction;    Left ventricular dysfunction;    Heart failure;   

DOI  :  10.1186/s13019-022-02061-9

 received in 2022-02-23, accepted in 2022-12-06,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundPatients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis.MethodsThe retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction.ResultsWithin the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067–1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929–1.080, p = 0.964), respectively.ConclusionsReduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention.Trial registration The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 1

Fig. 3