Relation of Preprocedural Assessment of Myocardial Contractility Reserve on Outcomes of Aortic Stenosis Patients With Impaired Left Ventricular Function Undergoing Transcatheter Aortic Valve Implantation

Meta-Analysis of the Prognostic Impact of Stroke Volume, Gradient, and Ejection Fraction After Transcatheter Aortic Valve Implantation

“…In contrast, there have been conflicting data regarding the impact of low EF and LG on outcomes after TAVI 1,2,[4][5][6][7][8][9][10][11][12][13][14][15][16] . In addition there have been varying definitions used for low flow, LG AS in the literature, with some studies using only EF for the definition, and others not incorporating SVI into the determination, further contributing to confusion.…”

“…The majority of studies presented adjusted hazard ratios for 1 year all-cause mortality (n=11) or cardiovascular mortality (n=1), whereas 3 studies presented unadjusted 1 year all-cause mortality. Most studies adjusted for age, sex, logistic Euroscore and/or Society for Thoracic Surgeons (STS) score, while some adjusted for history of peripheral vascular disease (6,8,9,14), prior cerebrovascular event (13,14,18) prior coronary artery bypass grafting surgery (6,8,14), and postprocedural aortic regurgitation (3,10,12,13,18).…”

“…A C C E P T E D ACCEPTED MANUSCRIPT 6 A study selection process flow chart detailing the number of studies identified, evaluated and excluded is shown in Figure 1. A total of 16 studies were included in the final analysis, enrolling 7673 patients ( Figure 1).…”

Transcatheter aortic valve implantation in low ejection fraction/low transvalvular gradient patients

“…Conversely, the role of DSE in TAVI patients is debated and only few studies have specifically addressed this issue. Recently, Barbash et al 23 showed a nonsignificantly higher mortality in patients undergoing TAVI without left ventricle flow reserve. Similarly, in a study of 59 patients who underwent to DSE before TAVI patients with no left ventricle reserve (n ¼ 27) suffered a worse outcome.…”

Transcatheter aortic valve replacement and standard therapy in inoperable patients with aortic stenosis and low EF

“…This improvement in LV systolic function during standard therapy is largely attributable to optimisation of medical management as well as to balloon aortic valvuloplasty (BAV) 19 20. Patients with LV systolic dysfunction and severe AS are exquisitely sensitive to afterload,21 and previous studies have shown that the modest reductions in LV pressure load seen with BAV can lead to improved LV function 22 23…”