University of Oulu

Jalava, M.P., Savontaus, M., Ahvenvaara, T. et al. Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction. J Cardiothorac Surg 17, 322 (2022).

Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction

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Author: Jalava, Maina P.1; Savontaus, Mikko1; Ahvenvaara, Tuomas2;
Organizations: 1Heart Centre, Turku University Hospital and University of Turku, P. O. Box 52, 20521, Turku, Finland
2Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
3Heart Center, Helsinki University Hospital, Helsinki, Finland
4Heart Hospital, Tampere University Hospital and University of Tampere, Tampere, Finland
5Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
6Heart Center, Kuopio University Hospital, Kuopio, Finland
7National Centre of Global Health, Istituto Superiore di Sanità, Rome, Italy
8Clinica Montevergine, GVM Care and Research, Mercogliano, Italy
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2023-06-29


Background: Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis.

Methods: The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction.

Results: Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067–1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929–1.080, p = 0.964), respectively.

Conclusions: Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention.

Trial registration: The FinnValve registry Identifier: NCT03385915.

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Series: Journal of cardiothoracic surgery
ISSN: 1749-8090
ISSN-E: 1749-8090
ISSN-L: 1749-8090
Volume: 17
Issue: 1
Article number: 322
DOI: 10.1186/s13019-022-02061-9
Type of Publication: A1 Journal article – refereed
Field of Science: 312 Clinical medicine
Funding: This work was supported by the Department of Clinical Medicine University of Turku, the Finnish Foundation for Cardiovascular Research and the Finnish Cultural Foundation. The FinnValve trial is carried out without funding.
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