Abstract
There is limited data on whether development of patient-prosthesis mismatch (PPM) depends on left ventricular function at the time of TAVR, especially with newer generation transcatheter heart valves (THVs). Our study sought to investigate the predictive value of left ventricular ejection fraction (LVEF) on development of PPM, as well as long-term clinical outcomes of PPM in patients with preserved, mid-range, and reduced ejection fraction.
This is a retrospective cohort study of patients with preserved (EF > 50%), mid-range (EF 40-50%), and reduced (EF < 40%) ejection fraction that underwent TAVR between April 2012 to Feb 2019 in a single cardiovascular center. Evaluated outcomes were incidence of PPM, 30-day mortality, 1-year mortality, length of stay (LOS) and vascular complications.
A total of 991 patients underwent TAVR. There were 423 (43%) females with median age of 85, STS score of 4.9 and LVEF of 60%. There were 657 (66%) patients received Sapien 3 THVs and 60 (6%) received Evolut R/Pro THVs. A total of 274 patients (28%) developed PPM. There were 58 (21%) patients with reduced EF, 38 (14%) patients with mid-range EF, and 178 (65%) with preserved EF who developed PPM (p=0.92). Outcomes of these patients are presented in Table 1. Reduced EF was significantly associated with lower 5-year mortality (Figure 1).
Our study suggests that left ventricular function at the time of TAVR is not a predictor for development of PPM. LVEF does not appear to have impact on short-term clinical outcomes of PPM; however, it does appear to associate with decreased long-term survival. Larger randomized controlled trials are needed to further investigate the impact of LVEF.
