In patients undergoing transcatheter aortic valve replacement (TAVR), low aortic valve gradient (AVG), but not left ventricular (LV) dysfunction, was associated with higher mortality and a greater risk of recurrent heart failure, according to a study published May 16 in the Journal of the American College of Cardiology. However, the study further showed that, “neither severe LV dysfunction nor low AVG alone or in combination provide sufficient prognostic discrimination to preclude treatment with TAVR.”

Using data from the STS/ACC TVT Registry linked with Medicare claims data, researchers examined records from 11,292 patients who had the procedure performed between November 2011 and June 2014. Results showed that at the one-year mark, patients with severe LV dysfunction had the highest mortality rate, compared to patients with LV function closer to normal: 29.3 percent vs. 21.9 percent. Similarly patients with a low AVG had a higher one-year mortality rate than those with a high AVG: 27.1 percent vs. 21.5 percent.

Patients with a combination of preserved LV function and a high AVG had the most favorable clinical outcomes at one year, with a mortality rate of 23.6 percent and heart failure at 11.2 percent. Patients with severe LV function and a low AVG had the least favorable clinical outcomes, with a mortality rate of 33.1 percent and heart failure at 23.6 percent.

According to Suzanne J. Baron, MD, MSc, the study’s lead author, the finding that LV dysfunction was not independently associated with long-term mortality after adjusting for clinical factors, “provides important reassurance regarding the benefits of TAVR, even in patients with severe LV dysfunction.”

In an accompanying editorial, Philippe Pibarot, DVM, PhD, FACC, and John Webb, MD, FACC, note that the presence of a low gradient, low LV ejection fraction and/or low flow “should not preclude the consideration of aortic valve repair but should be interpreted as a marker for higher risk of procedural and post-procedural complications and adverse events.” Moving forward, they suggested requiring individualized risk stratification to determine the best type and timing of therapy. 

Keywords: Aortic Valve, Heart Failure, Medicare, Registries, Transcatheter Aortic Valve Replacement, Ventricular Dysfunction, Left, Ventricular Function, Left, Diabetes Collaborative Registry, National Cardiovascular Data Registries

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