REDUCED EJECTION FRACTION IS ASSOCIATED WITH INCREASED CARDIOVASCULAR MORTALITY AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: INSIGHTS FROM A LARGE SINGLE CENTER COHORT

Background
Indications and outcomes from Trans-catheter Valve Replacement (TAVR) continue to increase and improve. It is unclear if the survival in patients with low ejection fraction are the same.

Methods
We performed a retrospective analysis of our institutional data from December 2011 to April 2018. We examined 1884 patients, 555 out of them had low EF (defined as < 50%). Patient and procedural factors were identified and examined. The rate and outcomes of survival at 30 days were analyzed.

Results
Our results indicate that survival in patients with low LVEF < 50% are lower than those with LVEF > 50% (95.8% vs 97.5%, p= 0.05) at 30 days. Majority of patients were Male (67%), Caucasians (89%) with Median age of 79. Among non-survivors in patients with low LVEF, patients were more likely to have cardiac arrest (9% vs 1%, p=0.002), and Cardiogenic shock (5% vs 22%, p=0.001). Length of stay was shorter in survivors vs. non-survivors (6 days versus 14, P =0.0078). Urgent and emergent TAVR procedures had lower rates of survival than those done electively. Non-survivors tend to stay in ICU for > 72 hours compared to survivors (P<0.0001). Mean AV gradient post valve deployment was not statistically different.

Trans Thoracic Echo Ejection Fraction	Survivors (N)	Total (N)	Survival %
20-25%	111	119	93.2%	P-value= 0.281
26-39%	251	260	96.5%
40-49%	170	176	96.5%
Low EF <50%	532	555	95.8%	P-value = 0.05
>= 50%	1296	1329	97.5

Conclusions
TAVR in low LVEF patients appears to carry a higher morbidity and mortality. Post procedural mean gradients do not impact the short-term mortality. Mortality in low EF cohort is independent of the degree of LV dysfunction. However, long term randomized data is warranted in this meaningful cohort of patients.