INTRODUCTION:

Patients with severe aortic stenosis (AS) associated with left ventricular dysfunction have higher surgical risk and ought to receive expeditious treatment, compared to patients with preserved ventricular function. During the COVID-19 pandemic, such patients endured longer surgical wait and reduced clinical follow-up. Transcatheter Aortic Valve Replacement (TAVR) is a safe treatment option in this setting, however data in the treatment of patients with severely depressed left ventricular ejection fraction (LVEF <=35%) are scarce.

OBJECTIVE:

To evaluate the clinical outcomes and changes in left ventricular ejection fraction (LVEF) after TAVR in patients with severe AS and severely depressed LVEF.

METHODS:

Seventy-eight (78) TAVR procedures were analyzed from September 15, 2020 to March 24, 2022. Nine (09) patients with severely depressed LVEF (<=35%), whose TAVR indication was determined by a Heart Team, were identified.

RESULTS:

Mean age was 69 years, and 67% were male. Mean STS Score was 4.1%. 78% of patients presented at a NYHA functional class <=III. Mean gradient and aortic valve area (AVA) were respectively 56mmHg and 0,56cm2. All the procedures were performed with a minimalistic approach and were successful. One of the patients required a definitive pacemaker implant. Four out of eight patients (1 missed follow-up) improved LVEF (at least 5% increase) and one had a normal LVEF after 1 month follow-up. In-hospital stay was a mean of 2 days, excepting the patients with the pacemaker implant, who had a late hospital discharge. There were no major adverse effects at the 1-month follow-up period, according to the VARC-3 criteria. Eight of the nine patients presented clinical improvement (NYHA I) at follow-up. Table 1 shows the data presented.

CONCLUSIONS:

In patients with severe AS and a severely depressed LVEF, TAVR was a safe and effective procedure, with clinical and echocardiographic improvement verified in short follow-up.