Comparison of therapeutic effects of transcatheter aortic valve replacement surgeryon patients with severe aortic valve stenosis with different ejection fractions

Abstract

Objective To investigate the efficacy of transcatheter aortic valve replacement (TAVR) in treating patients with severe aortic stenosis (AS) of different levels of cardiac function. Methods A retrospective analysis was conducted on clinical data of 72 patients who underwent TAVR for severe AS at the Xinjiang Uygur Autonomous Region People's Hospital from September 2016 to July 2022. Patients with a left ventricular ejection fraction (LVEF) ≥50% were included in the preserved ejection fraction group (group A, n=44), while those with LVEF＜50% were included in the reduced ejection fraction group (group B, n=28). The effective orifice area (EOA), mean transvalvular pressure gradient, and left ventricular remodeling (LVR) were observed in both groups preoperatively and postoperatively at 1 day, 3 months, and 12 months. The 6-minute walk distance (6-MWD) was measured preoperatively and postoperatively at 3 months and 12 months for both groups. All patients were followed up to one year postoperatively to observe the readmission rate due to heart failure. Results Both groups showed significant improvement in EOA and mean transvalvular pressure gradient on the first postoperative day, which remained stable thereafter. On the first postoperative day, LVR indicators ［left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular posterior wall thickness (LVPWT), LVEF］ improved significantly in both groups compared to preoperative values (P＜0.05). During subsequent follow-ups, group A maintained a relatively stable state, while group B continued to show LVR until the end of the follow-up period. The 6-MWD at 3 months postoperatively improved significantly in both groups compared to preoperative values and remained stable thereafter. The readmission rate due to heart failure within one year between group A and group B showed no statistically significant difference (4.54% vs 21.43%, χ2=3.380, P=0.066). Conclusion TAVR can effectively alleviate obstruction of the left ventricular outflow tract in patients with severe AS and different ejection fractions, improve exercise tolerance, and promote left ventricular reverse remodeling. For patients with preserved ejection fraction and severe AS, intervention should be carried out as early as possible.

Keywords

• aortic stenosis
• transcatheter aortic valve replacement
• transcatheter interventional treatment
• ventricular remodeling
• heart failure