Valvular & structural heart disease
Survival Outcomes of TAVR and Self-Expanding Versus Balloon-Expandable Valves in Patients with Advanced Cardiac Dysfunction
Authors' conclusion
In the setting of low LVEF, TAVR remains a safe and effective procedure not associated with an increased risk of complications and mortality. SEV implantation may likely result in superior survival outcomes in patients with advanced cardiac dysfunction.
Study context
- Population
- Patients with severe AS undergoing TAVR at Toulouse University Hospital, 2016–2020
- Participants
- 157 / 820 / 66 / 91
- Exposure
- TAVR in left ventricular ejection fraction (LVEF) ≤35% vs LVEF ≥50%; SEV vs BEV in LVEF ≤35%
- LVEF ≤ 35%n = 157
- LVEF ≥ 50%n = 820reference
- SEVn = 66
- BEVn = 91
- Outcome
- Long-term survival / all-cause mortality
- Follow-up
- 3.4 years
Methodological detailssingle-centre, Living status observed in December 2022
- Single-centre
- Living status observed in December 2022
Main finding
As reported in the abstract
Hazard ratio
3.276
95% CI 1.520–7.060
P = 0.002
By group
BEVvs SEV
HR 3.276 (95% CI 1.520–7.060); P = 0.002
- No difference in long-term survival, LVEF ≤ 35% vs LVEF ≥ 50%
- P = 0.268
- Better survival after SEV (Kaplan-Meier)
- P = 0.032
Observational data: associations, not effects.
Further findings
| Outcome | LVEF ≤ 35% | LVEF ≥ 50% | SEV | BEV |
|---|---|---|---|---|
| Procedural success | 97.5% | 97.9% | — not stated in the abstract | — not stated in the abstract |
| Post-TAVR mean aortic gradient (LVEF ≤ 35%) | — not stated in the abstract | — not stated in the abstract | 7.8 (SD 4.2) | 10.2 (SD 3.6) |
— not stated in the abstract
Early LVEF improvement (LVEF ≤ 35%)
- LVEF from 29.2 ± 5.5 to 37.4 ± 10.8
Safety
| Outcome | LVEF ≤ 35% | LVEF ≥ 50% |
|---|---|---|
| In-hospital complications (LVEF ≤ 35% vs LVEF ≥ 50%) | ||
| AKI | 3.8% | 2.2% |
| Major bleeding | 2.5% | 3.2% |
| Stroke | 1.3% | 1.6% |
| Pacemaker implantation | 10.2% | 10.7% |
| Major vascular complication | 4.5% | 4.5% |
| New-onset AF | 3.2% | 3.4% |
| In-hospital death | 3.2% | 2.8% |
In-hospital complications (LVEF ≤ 35% vs LVEF ≥ 50%)
- Similar between groups
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Survival Outcomes of TAVR and Self-Expanding Versus Balloon-Expandable Valves in Patients with Advanced Cardiac Dysfunction. ESC Heart Fail. Published 6 February 2024. doi:10.
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