Outcomes Among Patients With Heart Failure With Reduced Ejection Fraction Undergoing Transcatheter Aortic Valve Replacement: Minimally Invasive Strategy Versus Conventional Strategy

Muhammad S. Panhwar, Jun Li, David A. Zidar, Joshua Clevenger, Jerry Lipinski, Toral R. Patel, Adham Karim, Petar Saric, Sandeep M. Patel, Ankur Kalra, Guilherme Attizzani

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To investigate the effect of TAVR technique on in-hospital and 30-day outcomes in patients with aortic stenosis (AS) and reduced ejection fraction (EF). BACKGROUND: Patients with AS and concomitant low EF may be at risk for adverse hemodynamic effects from general anesthesia utilized in transcatheter aortic valve replacement (TAVR) via the conventional strategy (CS). These patients may be better suited for the minimally invasive strategy (MIS), which employs conscious sedation. However, data are lacking that compare MIS to CS in patients with AS and concomitant low EF. METHODS: In this retrospective study, we identified all patients with low EF (<50%) undergoing transfemoral MIS-TAVR vs CS-TAVR between March 2011 and May 2018. Our primary endpoint was defined as the composite of in-hospital mortality and major periprocedural bleeding or vascular complications. RESULTS: Two hundred and seventy patients had EF <50%, while 154 patients had EF ≤35%. Overall, a total of 236 patients were in the MIS group and 34 were in the CS group. Baseline characteristics between the two groups were similar except for Society of Thoracic Surgeons (STS) score (MIS 8.4 ± 5.1 vs CS 11.7 ± 6.8; P<.01). There were no differences between the two groups in incidence of the primary endpoint (MIS 5.5% vs CS 8.8%; odds ratio for MIS, 0.60; 95% confidence interval, 0.16-2.23; P=.45). CONCLUSIONS: In patients with severe AS and reduced EF, MIS was not associated with adverse in-hospital or 30-day clinical outcomes compared with CS. In these patients, MIS may be a suitable alternative to CS without compromising clinical outcomes.

Original languageEnglish (US)
Pages (from-to)15-20
Number of pages6
JournalThe Journal of invasive cardiology
Volume31
Issue number3
StatePublished - Mar 1 2019

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Heart Failure
Aortic Valve Stenosis
Transcatheter Aortic Valve Replacement
Conscious Sedation
Hospital Mortality
General Anesthesia
Blood Vessels
Retrospective Studies
Hemodynamics
Odds Ratio
Confidence Intervals
Hemorrhage
Incidence

Keywords

  • anesthesia
  • aortic stenosis
  • conscious sedation
  • heart failure
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes Among Patients With Heart Failure With Reduced Ejection Fraction Undergoing Transcatheter Aortic Valve Replacement : Minimally Invasive Strategy Versus Conventional Strategy. / Panhwar, Muhammad S.; Li, Jun; Zidar, David A.; Clevenger, Joshua; Lipinski, Jerry; Patel, Toral R.; Karim, Adham; Saric, Petar; Patel, Sandeep M.; Kalra, Ankur; Attizzani, Guilherme.

In: The Journal of invasive cardiology, Vol. 31, No. 3, 01.03.2019, p. 15-20.

Research output: Contribution to journalArticle

Panhwar, MS, Li, J, Zidar, DA, Clevenger, J, Lipinski, J, Patel, TR, Karim, A, Saric, P, Patel, SM, Kalra, A & Attizzani, G 2019, 'Outcomes Among Patients With Heart Failure With Reduced Ejection Fraction Undergoing Transcatheter Aortic Valve Replacement: Minimally Invasive Strategy Versus Conventional Strategy', The Journal of invasive cardiology, vol. 31, no. 3, pp. 15-20.
Panhwar, Muhammad S. ; Li, Jun ; Zidar, David A. ; Clevenger, Joshua ; Lipinski, Jerry ; Patel, Toral R. ; Karim, Adham ; Saric, Petar ; Patel, Sandeep M. ; Kalra, Ankur ; Attizzani, Guilherme. / Outcomes Among Patients With Heart Failure With Reduced Ejection Fraction Undergoing Transcatheter Aortic Valve Replacement : Minimally Invasive Strategy Versus Conventional Strategy. In: The Journal of invasive cardiology. 2019 ; Vol. 31, No. 3. pp. 15-20.
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abstract = "OBJECTIVES: To investigate the effect of TAVR technique on in-hospital and 30-day outcomes in patients with aortic stenosis (AS) and reduced ejection fraction (EF). BACKGROUND: Patients with AS and concomitant low EF may be at risk for adverse hemodynamic effects from general anesthesia utilized in transcatheter aortic valve replacement (TAVR) via the conventional strategy (CS). These patients may be better suited for the minimally invasive strategy (MIS), which employs conscious sedation. However, data are lacking that compare MIS to CS in patients with AS and concomitant low EF. METHODS: In this retrospective study, we identified all patients with low EF (<50{\%}) undergoing transfemoral MIS-TAVR vs CS-TAVR between March 2011 and May 2018. Our primary endpoint was defined as the composite of in-hospital mortality and major periprocedural bleeding or vascular complications. RESULTS: Two hundred and seventy patients had EF <50{\%}, while 154 patients had EF ≤35{\%}. Overall, a total of 236 patients were in the MIS group and 34 were in the CS group. Baseline characteristics between the two groups were similar except for Society of Thoracic Surgeons (STS) score (MIS 8.4 ± 5.1 vs CS 11.7 ± 6.8; P<.01). There were no differences between the two groups in incidence of the primary endpoint (MIS 5.5{\%} vs CS 8.8{\%}; odds ratio for MIS, 0.60; 95{\%} confidence interval, 0.16-2.23; P=.45). CONCLUSIONS: In patients with severe AS and reduced EF, MIS was not associated with adverse in-hospital or 30-day clinical outcomes compared with CS. In these patients, MIS may be a suitable alternative to CS without compromising clinical outcomes.",
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AU - Zidar, David A.

AU - Clevenger, Joshua

AU - Lipinski, Jerry

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AU - Karim, Adham

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AB - OBJECTIVES: To investigate the effect of TAVR technique on in-hospital and 30-day outcomes in patients with aortic stenosis (AS) and reduced ejection fraction (EF). BACKGROUND: Patients with AS and concomitant low EF may be at risk for adverse hemodynamic effects from general anesthesia utilized in transcatheter aortic valve replacement (TAVR) via the conventional strategy (CS). These patients may be better suited for the minimally invasive strategy (MIS), which employs conscious sedation. However, data are lacking that compare MIS to CS in patients with AS and concomitant low EF. METHODS: In this retrospective study, we identified all patients with low EF (<50%) undergoing transfemoral MIS-TAVR vs CS-TAVR between March 2011 and May 2018. Our primary endpoint was defined as the composite of in-hospital mortality and major periprocedural bleeding or vascular complications. RESULTS: Two hundred and seventy patients had EF <50%, while 154 patients had EF ≤35%. Overall, a total of 236 patients were in the MIS group and 34 were in the CS group. Baseline characteristics between the two groups were similar except for Society of Thoracic Surgeons (STS) score (MIS 8.4 ± 5.1 vs CS 11.7 ± 6.8; P<.01). There were no differences between the two groups in incidence of the primary endpoint (MIS 5.5% vs CS 8.8%; odds ratio for MIS, 0.60; 95% confidence interval, 0.16-2.23; P=.45). CONCLUSIONS: In patients with severe AS and reduced EF, MIS was not associated with adverse in-hospital or 30-day clinical outcomes compared with CS. In these patients, MIS may be a suitable alternative to CS without compromising clinical outcomes.

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