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Efficacy of transcatheter aortic valve implantation in patients with aortic stenosis and reduced LVEF

A systematic review

Wirksamkeit der Aortenklappenimplantation via Katheter bei Patienten mit Aortenstenose und verminderter LVEF

Eine systematische Übersicht

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Abstract

Background

Transcatheter aortic valve implantation (TAVI) is safe and effective for patients with aortic stenosis (AS) who have a high operative risk. However, there is still debate on the effect of TAVI in AS patients with reduced left ventricular ejection fraction (REF). The objective of the review is to clarify the efficacy of TAVI and the impact of REF on the 30-day and midterm mortality in these patients.

Methods

Studies on TAVI were searched in PubMed, Embase, and the Cochrane Library databases and were included in this review following predefined criteria. Data were extracted and pooled risk ratios (RR) were synthesized to explore the relationship between REF and 30-day plus midterm mortality.

Results

Twenty-eight studies comprising 14,099 patients were included in the analysis of the association of REF with the prognosis of patients after TAVI. An average increase in left ventricular ejection fraction of 8–10 % was observed among these patients after TAVI. REF was not related to the 30-day mortality [RR = 1.90, 95 % confidence interval (CI) = 0.80–4.47]; however, it was related to the midterm mortality (RR = 1.49, 95 %CI = 1.14–1.93) of patients undergoing TAVI. Patients with low-flow and low-gradient AS had a higher 30-day mortality (RR = 1.54, 95 %CI = 1.11–2.13) and midterm mortality rate (RR = 1.69, 95 %CI = 1.33–2.14) compared with AS patients without these characteristics. The mortality of TAVI patients was significantly lower than that of those undergoing conservative therapy, and was similar to that of patients undergoing surgical aortic valve replacement.

Conclusion

REF was not associated with 30-day mortality, but it was associated with the midterm mortality of TAVI patients. Patients with REF could benefit from TAVI compared with conservative therapy.

Zusammenfassung

Hintergrund

Die Transkatheter-Aortenklappenimplantation (TAVI) ist sicher und wirksam bei Patienten mit Aortenstenose (AS) und hohem Operationsrisiko. Jedoch ist die Wirksamkeit der TAVI bei AS-Patienten mit verminderter linksventrikulärer Ejektionsfraktion (LVEF) umstritten. Ziel der vorliegenden Übersicht war es, die Wirksamkeit der TAVI und die Auswirkungen einer verminderten LVEF auf die 30-Tage- und mittelfristige Mortalität bei diesen Patienten zu klären,

Methoden

Es wurde nach Studien zur TAVI in den Datenbanken PubMed, Embase und Cochrane Library gesucht. Diese Studien wurden nach vorher festgelegten Kriterien in die Auswertung einbezogen. Die Daten wurden extrahiert und die gepoolten relativen Risiken ermittelt, um die Beziehung zwischen einer verminderten LVEF und der 30-Tage- bzw. der mittelfristigen Mortalität zu untersuchen.

Ergebnisse

Es wurden 28 Studien mit 14.099 Patienten in die Auswertung eingeschlossen, um den Zusammenhang zwischen einer verminderten LVEF und der Prognose von Patienten nach TAVI zu ermitteln. Ein durchschnittlicher Anstieg von 8–10 % des LVEF wurde bei diesen Patienten nach TAVI festgestellt. Eine verminderte LVEF war nicht mit der 30-Tage-Mortalität assoziiert [RR = 1,90; 95 %-Konfidenzintervall (CI): 0,80–4,47], jedoch mit der mittelfristigen Mortalität (RR = 1,49; 95 %-KI: 1,14–1,93) der Patienten, bei denen eine TAVI erfolgte. Patienten mit niedrigem Fluss und niedrigem Gradienten der AS wiesen im Vergleich zu AS-Patienten ohne diese Merkmale eine höhere 30-Tage- (RR = 1,54; 95 %-KI: 1,11–2,13) und mittelfristige Mortalität auf (RR = 1,69; 95 %-KI: 1,33–2,14). Die Mortalität der TAVI-Patienten war deutlich niedriger als bei konservativer Therapie und ähnlich wie bei einer Aortenklappenersatzoperation.

Schlussfolgerung

Eine verminderte LVEF war nicht mit der 30-Tage-Mortalität, aber mit der mittelfristigen Mortalität von TAVI-Patienten assoziiert. Patienten mit verminderter LVEF konnten gegenüber der konservativen Therapie von der TAVI profitieren.

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Compliance with ethical guidelines

Conflict of interest. X. Luo, Z. Zhao, H. Chai, C. Zhang, Y. Liao, Q. Li, Y. Peng, W. Liu, X. Ren, Q. Meng, C. Chen, M. Chen, Y. Feng, and D. Huang state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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  1. Department of Cardiology, West China Hospital of Sichuan University, No.37 Guo Xue Xiang of Wuhou District, 610041, Chengdu, Sichuan, P.R. China

    X. Luo, Z. Zhao, H. Chai, C. Zhang, Y. Liao, Q. Li, Y. Peng, W. Liu, X. Ren, Q. Meng, C. Chen, M. Chen, Y. Feng & D. Huang

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  1. X. Luo
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  2. Z. Zhao
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  3. H. Chai
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Correspondence to M. Chen.

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Luo, X., Zhao, Z., Chai, H. et al. Efficacy of transcatheter aortic valve implantation in patients with aortic stenosis and reduced LVEF. Herz 40 (Suppl 2), 168–180 (2015). https://doi.org/10.1007/s00059-014-4193-z

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  • DOI: https://doi.org/10.1007/s00059-014-4193-z

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