Transcatheter aortic valve replacement beneficial in patients with severely reduced left ventricle ejection fraction: does the type of valve also matter?

Abstract

Aortic stenosis is a disease mainly affecting older patients, and most of them have preserved left ventricle ejection fraction. 1 In this issue of ESC Heart Failure, Matta et al. analyse data from the FRANCE-TAVI Registry to assess the safety, efficacy, and outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe cardiac dysfunction. 2 In the study, the group of 157 patients with left ventricular ejection fraction (LVEF) below ≤35% was compared with their 820 counterparts with normal cardiac function.Data on the outcomes of TAVR in patients with severe LV dysfunction are sparse, even though in daily clinical practice, such patients may represent up to 13% of those undergoing TAVR. 3 Many factors may predict or influence the long-term outcomes after the TAVI identified already. 4-7 Matta's retrospective, single-centre cohort study offers valuable insights into a group of patients that have often been poorly represented or excluded in previous trials and analyses.The study's primary endpoint was to assess the success rate, risk of complications, changes in LVEF, and survival post-TAVR in patients with severely reduced versus preserved LVEF. The secondary endpoint was to compare survival outcomes post-TAVR in patients with LVEF ≤35% treated with self-expanding valves (SEV) versus balloon-expandable valves BEV.Characteristics of patients and TAVR procedures in those with LVEF <35% and >50% differed by several variables that may have a prognostic impact, but mainly in favour of the normal LV group. However, during a mean follow-up of more than 3 years, no differences in all-cause mortality were observed between both groups at different time points. There is conflicting information on whether LVEF is a risk factor for poor TAVR outcome. [8][9][10][11] Matta et al. observation indicates that baseline left ventricular function may be not the main dominant predictor of postoperative prognosis, and patients with severely depressed LVEF may benefit from TAVR comparably to patients with preserved LVEF.