Early Recovery of Left Ventricular Systolic Function After CoreValve Transcatheter Aortic Valve Replacement

Abstract

Background-Approximately one third of patients with symptomatic aortic stenosis have reduced left ventricular ejection fraction (LVEF) before transcatheter aortic valve replacement. The incidence, predictors, and significance of early LVEF recovery after CoreValve transcatheter aortic valve replacement have not been described. Methods and Results-We studied 156 patients from the CoreValve Extreme and High-Risk trials with LVEF ≤40% at baseline who had 30-day LVEF data. All patients underwent core laboratory echocardiographic assessment of LVEF at baseline, post procedure, discharge, 30 days, 6 months, and 1 year. Early LVEF recovery was defined as an absolute increase of ≥10% in EF at 30 days. One-year outcomes were compared between patients with and without early recovery. Multivariable analysis was performed to determine independent predictors of early recovery. Early LVEF recovery occurred in 62% of patients, generally before discharge. By 30 days LVEF increased >17% compared with baseline in the early recovery group with minimal increase in the no-early recovery group (48.9±8.8% versus 31.5±6.9%; P<0.001).One-year all-cause mortality was numerically (but not statistically) higher in the no-early recovery group (24% versus 12%; P=0.07). Absence of previous myocardial infarction (odds ratio, 0.44; 95% confidence interval, 0.19-1.03) and baseline mean gradient ≥40 mm Hg (odds ratio, 4.59; 95% confidence interval, 1.76-11.96) were identified as predictors of early LVEF recovery. Conclusions-Nearly two thirds of patients with reduced LVEF will have a marked early improvement after transcatheter aortic valve replacement. Early LVEF recovery is associated with improved clinical outcomes and is most likely among patients with higher baseline aortic valve gradients and no previous myocardial infarction. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01240902.(Circ Cardiovasc Interv. 2016;9:e003425.

Transapical transcatheter aortic valve replacement with the balloon expandable aortic bioprosthetic valve in high risk patients with severe aortic stenosis: Intermediate-term results from the register of the clinic of cardiac surgery

“…We observed a signifi cant increase in the left ventricular ejection fraction and a signifi cant decrease in the left ventricular enddiastolic diameter after the procedure. Other authors presented similar results (24,25) and our fi ndings concur with the PARTNER trial fi nding that included patients with left ventricular dysfunction between 40-50 % (1, 2).…”

Immediate improvement of left ventricular mechanics following transcatheter aortic valve replacement

“…While both kinds of valve showed similar changes in transaortic gradients and AVA after the procedure, the group receiving the self-expanding valve achieved a statistically significant improvement in LV systolic function as assessed by the Simpson biplane method, which could in turn explain the difference in GLS improvement. Although previous studies have also shown an early improvement in LV systolic function with the self-expanding valve [20], the reason for this difference in early LV mechanic behaviour remains unclear and should be clarified in further studies.…”

Transcatheter aortic valve replacement: The year in review 2016

“…About a third of patients undergoing TAVR present with depressed LV ejection fraction (LVEF). In 156 patients in the Core Valve Extreme and High Risk trials, early LVEF recovery (>10% improvement in LVEF by 30 days) occurred in 62% of patients, and was associated with better 1‐year survival than the no‐early recovery group (12% vs 24%; P = 0.07). Absence of previous myocardial infarction and baseline mean gradient ≥40 mm Hg were identified as predictors of early LVEF recovery.…”