TAVR vs Surgical Aortic Valve Replacement for Aortic Stenosis with LV Dysfunction

Sammy Elmariah, MD, MPH Massachusetts General Hospital Boston, MA MedicalResearch.com Interview with:
Sammy Elmariah, MD, MPH
Massachusetts General Hospital
Boston, MA

 

MedicalResearch.com: What are the main findings of the study?

Dr. Elmariah: Within the randomized PARTNER I trial, we evaluated the effect of left ventricular (LV) dysfunction on clinical outcomes after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) and the impact of valve replacement technique on recovery of LV function. We found that LV dysfunction, defined as an LV ejection fraction < 50%, had no impact on 30-day and 1-year mortality after either TAVR or SAVR. In those with baseline LV dysfunction, marked improvement in LV ejection fraction was observed within 30-days of valve replacement in approximately half of patients, with an equivalent degree of improvement observed after TAVR and SAVR. Permanent pacemaker at study entry, low mean aortic valve gradient, and high LV ejection fraction were associated with reduced odds of LV functional recovery after valve replacement.


MedicalResearch.com: Were any of the findings unexpected?

Dr. Elmariah: Yes, we found that patients with LV dysfunction that did not demonstrate improvement in LV function within 30-days of TAVR possessed an increased risk of death at 1-year follow-up. Surprisingly, lack of early LV functional improvement did not influence clinical outcomes after SAVR. The reason for this discrepancy is not readily apparent, although we suspect that injury of the LV during transapical TAVR, paravalvular aortic regurgitation, and conduction abnormalities after TAVR may be involved.

MedicalResearch.com: What should clinicians and patients take away from this study?

Dr. Elmariah: Our findings highlight the beneficial impact of aortic valve replacement in patients with aortic stenosis and LV dysfunction and demonstrate that TAVR should be considered a feasible alternative to SAVR regardless of the presence of LV systolic dysfunction.

MedicalResearch.com: What further research do you recommend as a result of your study?

Dr. Elmariah: Further efforts are needed to identify the reasons responsible for poor clinical outcomes in patients with persistent LV dysfunction after TAVR. If in fact LV injury during transapical TAVR is found to mediate this observation, alternative approaches may prove to be beneficial in patients with LV dysfunction undergoing TAVR.

Citation:

Outcomes of Transcatheter and Surgical Aortic Valve Replacement in High-Risk Patients With Aortic Stenosis and Left Ventricular Dysfunction: Results From the Placement of Aortic Transcatheter Valves (PARTNER) Trial (Cohort A)

Sammy Elmariah, Igor F. Palacios, Thomas McAndrew, Irene Hueter, Ignacio Inglessis, Joshua N. Baker, Susheel Kodali, Martin B. Leon, Lars Svensson, Philippe Pibarot, Pamela S. Douglas, William F. Fearon, Ajay J. Kirtane, Hersh S. Maniar, and Jonathan J. Passeri

Circ Cardiovasc Interv. 2013;CIRCINTERVENTIONS.113.000650published online before print November 12 2013, doi:10.1161/CIRCINTERVENTIONS.113.000650