Comparison of Outcomes of Patients With Left Ventricular Ejection Fractions ≤30% Versus ≥30% Having Transcatheter Aortic Valve Implantation (from the.

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Comparison of Outcomes of Patients With Left Ventricular Ejection Fractions ≤30% Versus ≥30% Having Transcatheter Aortic Valve Implantation (from the German Transcatheter Aortic Valve Interventions Registry) Ulrich Schaefer, MD, Ralf Zahn, MD, Mohamed Abdel-Wahab, MD, Ulrich Gerckens, MD, Axel Linke, MD, Steffen Schneider, PhD, Holger Eggebrecht, MD, Horst Sievert, MD, Hans Reiner Figulla, MD, Jochen Senges, MD, Karl Heinz Kuck, MD American Journal of Cardiology Volume 115, Issue 5, Pages 656-663 (March 2015) DOI: 10.1016/j.amjcard.2014.12.019 Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 1 Change in congestive heart failure as classified by the NYHA at baseline, 30 days, and 1 year after TAVI (distribution in %). There is a significant shift toward a similar distribution to NYHA class I and II in patients with LVEF ≤30% and LVEF >30% (A). Self-assessment at baseline, 30 days, and 1 year after TAVI (mean ± SEM; scale between 0 = worst condition and 100 = best condition). Note: There is a significant larger gain in patients with LVEF ≤30% compared with LVEF >30% (B). American Journal of Cardiology 2015 115, 656-663DOI: (10.1016/j.amjcard.2014.12.019) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 2 ASA classification in accordance to the American Society of Anesthesiologists (ASA 1 = a normal healthy patient; ASA 2 = patient with mild systemic disease; ASA 3 = patient with severe systemic disease; ASA 4 = patient with severe systemic disease, i.e., a constant threat to life; ASA 5 = moribund patient who is not expected to survive with or without the operation) before TAVI. Patients with an LVEF ≤30% are significantly more prevalent in ASA classes 4 and 5 compared with patients with an LVEF >30% (25% vs 11%) (A). TAVI procedures were more frequently performed in urgent or emergency situations in patients with an LVEF ≤30% compared with LVEF >30% (B). American Journal of Cardiology 2015 115, 656-663DOI: (10.1016/j.amjcard.2014.12.019) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 3 (A) Kaplan-Meier survival curves of patients who underwent TAVI with LVEF ≤30% and >30%. There is a significant higher mortality in patients with LVEF ≤30% compared with LVEF >30% at 30 days (p <0.01) and 1 year (p <0.0001). (B) Despite similar procedural success rates, patients with LVEF ≤30% display a significant higher postprocedural cardiac low output syndrome (p <0.01) and are more often in need of resuscitation (p <0.05). American Journal of Cardiology 2015 115, 656-663DOI: (10.1016/j.amjcard.2014.12.019) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 4 (A and B) Kaplan-Meier survival curves of patients who underwent TAVI with an LVEF ≤30%, >30% to ≤40%, >40% to ≤50%, and LVEF >50%, respectively. There is a significant higher mortality in patients with LVEF ≤30% compared with the other groups (p <0.01), despite similar high procedural success rates. Interestingly, patients with an LVEF >40% to ≤50% and >50% display a similar mortality as opposed to an intermediate mortality in patients with an LVEF >30% to ≤40% (top panel). Despite similar procedural success rates in all groups, patients with LVEF ≤30% display a significant higher postprocedural cardiac low output syndrome (p <0.01) and are more often in need of resuscitation (p <0.05). American Journal of Cardiology 2015 115, 656-663DOI: (10.1016/j.amjcard.2014.12.019) Copyright © 2015 Elsevier Inc. Terms and Conditions