Transapical aortic valve implantation: Effects of poor left ventricular function on survival and myocardial contractility

Objectives: The purpose of this study was to identify what happens to the left ventricular function after transcatheter aortic valve implantation (TAVI) in patients with failing ventricles.

Methods: We compared left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDD) before TAVI and 1 week after TAVI in 96 patients with very poor and poor left ventricular function. There were 39 patients (41%) with LVEF of 20% and 57 patients (59%) with LVEF of 21-30%. The mean EuroSCORE II was 37 ± 23% (range 2-95%). Cardiogenic shock was present in 23 patients (24%).

Results: During the first week after TAVI, LVEF increased from 23.2 ± 6.4% to 40.3 ± 11.8% (p < 0.001) and LVEDD decreased from 57.2 ± 8.1 mm to 54.6 ± 8.1 mm (p < 0.001). More than 50% improvement in LVEF was found in 62 patients (65%) and 100% improvement in 37 patients (39%). Changes in LVEF were independent of the preoperative value (p = 0.208). Survival at 1, 2, and 4 years was 81 ± 5%, 64 ± 7%, and 45 ± 9%, respectively. There was no significant difference in survival in patients with LVEF of 20% and LVEF of 20-30% (p = 0.623).

Conclusions: In the majority of patients with failing ventricles, left ventricular function is quickly restored after TAVI and elimination of aortic stenosis. Without the additional trauma of cardioplegic arrest, TAVI is the potentially superior treatment option in patients with poor and very poor left ventricular performance.