Transcatheter Aortic Valve Replacement in Patients with Reduced Ejection Fraction and Nonsevere Aortic Stenosis

Autor: Sebastian Ludwig, Niklas Schofer, Mohamed Abdel-Wahab, Marina Urena, Guillaume Jean, Matthias Renker, Christian W. Hamm, Holger Thiele, Bernard Iung, Joris F. Ooms, Maya Wiessman, Nils S.B. Mogensen, Benjamin Longère, Nils Perrin, Walid Ben Ali, Augustin Coisne, Jordi S. Dahl, Nicolas M. Van Mieghem, Ran Kornowski, Won-Keun Kim, Marie-Annick Clavel
Přispěvatelé: Cardiology
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Circulation: Cardiovascular Interventions, 16(5):e012768. Lippincott Williams & Wilkins
ISSN: 0491-4481
1941-7640
Popis: Background: The potential benefit of transcatheter aortic valve replacement (TAVR) in patients with nonsevere aortic stenosis (AS) and heart failure is controversial. This study aimed to assess outcomes of patients with nonsevere low-gradient AS (LGAS) and reduced left ventricular ejection fraction undergoing TAVR or medical management. Methods: Patients undergoing TAVR for LGAS and reduced left ventricular ejection fraction ( Results: A total of 706 LGAS patients undergoing TAVR (TS-LGAS, N=527; PS-LGAS, N=179) and 470 Medical-Mod patients were included. After adjustment, both TAVR groups showed superior survival compared with Medical-Mod patients (all P P =0.96). After propensity score-matching among patients with nonsevere AS, PS-LGAS TAVR patients showed superior 2-year overall (65.4%) and cardiovascular survival (80.4%) compared with Medical-Mod patients (48.8% and 58.5%, both P ≤0.004). In a multivariable analysis including all patients with nonsevere AS, TAVR was an independent predictor of survival (hazard ratio, 0.39 [95% CI, 0.27–0.55]; P Conclusions: Among patients with nonsevere AS and reduced left ventricular ejection fraction, TAVR represents a major predictor of superior survival. These results reinforce the need for randomized-controlled trials comparing TAVR versus medical management in heart failure patients with nonsevere AS. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04914481.
Databáze: OpenAIRE
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