The impact of biventricular heart failure on outcomes after transcatheter aortic valve implantation
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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.
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.
KeywordsTAVI Heart failure Acute and long-term outcome
This work did not receive any funding.
Compliance with ethical standards
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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