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The impact of biventricular heart failure on outcomes after transcatheter aortic valve implantation

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Abstract

Aims

We sought to assess the impact of different manifestations of heart failure (HF) at baseline on the short- and long-term outcomes of transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS).

Methods and results

Of 361 patients undergoing TAVI between May 2013 and April 2015, 185 (51%) showed clinical signs of HF at the time of admission. HF was diagnosed as isolated left ventricular (LV) and biventricular in 63 (34%) and 122 patients (66%), respectively. Acute device success (VARC-2) was achieved in 97% of patients without HF, in all patients with LV HF, and in 97% of patients with biventricular HF. Follow-up for a median of 427 days revealed significantly poorer survival in patients with biventricular HF (1-year estimate, 72.1% [95% confidence interval, 64.0–80.2%]) than in patients with LV HF (84.5% [75.2–93.8%]; p = 0.0203) or no HF (94.3% [90.7–97.9%]; p < 0.0001). Survival in the latter two patient subgroups was statistically not different. A diagnosis of biventricular HF was associated with a hazard ratio of 2.62 (p = 0.0089) vs. no HF in the likelihood of death; NT-proBNP and the logistic EuroSCORE were not significantly associated with survival. Half of all deaths in patients with biventricular HF occurred within 42 days of TAVI.

Conclusion

Biventricular HF is a strong predictor of mortality following TAVI for severe AS. AS in patients with LV HF should be treated without delay to avoid progression to biventricular HF. Patients with AS and biventricular HF should be monitored closely after TAVI to possibly prevent early death.

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Authors and Affiliations

  1. Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany

    Tobias Schmidt, Mintje Bohné, Mitsunobu Kitamura, Dimitry Schewel, Jury Schewel, Karl-Heinz Kuck & Christian Frerker

  2. Asklepios Proresearch, Hamburg, Germany

    Michael Schlüter & Peter Wohlmuth

  3. Department of Cardiovascular Surgery, Asklepios Klinik St. Georg, Hamburg, Germany

    Michael Schmoeckel

Authors
  1. Tobias Schmidt
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  2. Mintje Bohné
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  3. Michael Schlüter
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  4. Mitsunobu Kitamura
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  5. Peter Wohlmuth
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  6. Dimitry Schewel
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  7. Jury Schewel
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  8. Michael Schmoeckel
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  9. Karl-Heinz Kuck
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  10. Christian Frerker
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Corresponding author

Correspondence to Tobias Schmidt.

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Conflict of interest

Tobias Schmidt has received lecture honoraria from Medtronic, as well as travel expenses from Edwards LifeSciences, Medtronic, and Boston Scientific. Christian Frerker has received lecture honoraria and travel expenses from Medtronic, Edwards Lifesciences, and Abbott Vascular. Karl-Heinz Kuck has received consultation fees from Medtronic, Boston Scientific, Biosense Webster, Edwards LifeSciences, and Abbott Vascular. The other authors report no conflicts of interest.

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Schmidt, T., Bohné, M., Schlüter, M. et al. The impact of biventricular heart failure on outcomes after transcatheter aortic valve implantation. Clin Res Cardiol 108, 741–748 (2019). https://doi.org/10.1007/s00392-018-1400-6

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  • DOI: https://doi.org/10.1007/s00392-018-1400-6

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