January 13, 2015

Transcatheter aortic valve replacement and standard therapy in inoperable patients with aortic stenosis and low EF

Structured PICO

Does transcatheter aortic valve replacement improve survival and LVEF recovery compared to standard therapy in inoperable patients with severe aortic stenosis and LV dysfunction?

Population

342 inoperable patients with severe aortic stenosis (Cohort B of the PARTNER trial)

Intervention

Transcatheter aortic valve replacement (TAVR)

Comparator

Standard therapy

Outcome

Clinical outcomes (survival, cardiac mortality) at 1 and 2 years, and LVEF recovery (absolute increase ≥10% at 30 days)hard clinical

In inoperable patients with severe aortic stenosis, TAVR improves survival regardless of baseline LV dysfunction, whereas standard therapy is associated with higher cardiac mortality in those with LV dysfunction.

Abstract

OBJECTIVES: The aims of this study were to evaluate the effect of left ventricular (LV) dysfunction on clinical outcomes after transcatheter aortic valve replacement (TAVR) and standard therapy for severe aortic stenosis (AS) and to assess LV ejection fraction (LVEF) recovery and its impact on subsequent clinical outcomes. METHODS: Cohort B of the Placement of AoRtic TraNscathetER Valves trial randomised 342 inoperable patients with severe AS to TAVR or standard therapy. We defined LV dysfunction as an LVEF 20%. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Unique Identifier #NCT00530894.

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