Influence of baseline ejection fraction on the prognostic value of paravalvular leak after transcatheter aortic valve implantation.

Background: Moderate or severe paravalvular leak (PVL ≥ moderate) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. The aim of this study was to assess whether the baseline ejection fraction (EF) affects the impact of PVL on mortality after TAVI.

Methods: We analyzed 514 consecutive patients with native severe aortic stenosis who underwent TAVI. Patients were divided into two groups: EF < 40% group (n = 84) and EF ≥ 40% group (n = 430) according to baseline EF.

Results: The mean age was 79.5 years and 49% were male. Patients in the EF < 40% group were younger and with higher logistic EuroSCORE compared to patients in the EF ≥ 40% group. Diabetes, coronary artery disease, atrial fibrillation and renal insufficiency were more prevalent in the EF < 40% group. Patients in the EF <40% group had more mitral regurgitation. In-hospital mortality was significantly higher in the EF < 40% group (8.3% vs. 0.9%, p < 0.0001). PVL ≥ moderate was significantly associated with increased 2-year estimated mortality only in the EF <40% group (65% vs. 20%, log-rank p < 0.0001) whereas no difference was seen in the EF ≥40% group (24% vs. 19%, log-rank p = 0.509). Interaction between PVL ≥ moderate and EF < 40% was statistically significant.

Conclusions: The impact of PVL ≥ moderate on mortality after TAVI was significant in the EF <40% group but not in the EF ≥ 40% group in our study. Even though operators should aim to minimize PVL in all TAVI patients, special attention is required for patients with reduced baseline EF.