{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:41:20Z","timestamp":1760125280544,"version":"build-2065373602"},"reference-count":13,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T00:00:00Z","timestamp":1679270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Treatment of congestive heart failure (CHF) with left ventricular (LV) systolic dysfunction and severe aortic stenosis (AS) is challenging, yet transcatheter aortic valve replacement (TAVR) has emerged as a suitable treatment option in such patients. We compared the periprocedural outcomes of TAVR in patients with an ejection fraction (EF) of \u226420% (VLEF group) to patients with an EF &gt; 20% to \u226440% (LEF group). We included patients with severe AS and reduced LV ejection fraction (LVEF \u2264 40%) who underwent TAVR at four centers within Northwell Health between January 2016 and December 2020. Over 2000 consecutive patients were analyzed, of which 355 patients met the inclusion criteria. The primary composite endpoint was in-hospital mortality, moderate or greater paravalvular (PVL), stroke, conversion to open surgery, aortic valve re-intervention, and\/or need for PPM. Secondary endpoints were length of stay, NYHA classification at 1 month and 1 year, mortality at 1 month and 1 year, mean valve gradient at 1 month, KCCQ score at 1 month, and \u2265 moderate PVL at 1 month. There was no difference in the primary composite endpoint between the two groups (23.6% for VLEF vs. 25.3% for LEF, p = 0.29). During TAVR placement, 40% of patients in the VLEF group required \u22651 vasopressors for hypotension lasting \u226530 min vs. only 21% of patients in the LEF group (p &lt; 0.01). Intra-aortic balloon pump (IABP) use during procedure was greater in the VLEF group (9% vs. 1%, p &lt; 0.01)\u2014all placed post TAVR. Emergency ECMO use was higher in the VLEF group as well (5% vs. 0%). Total length of stay was significantly different between the two groups as well (6 days vs. 3 days, p &lt; 0.01). Both groups had a change in LVEF of ~10%. One-year outcomes were similar between the groups. All-cause mortality at 1 year was not significantly different at 1 year (13% for VLEF vs. 11% for LEF), and KCC scores were also similar (77.54 vs. 74.97). Mean aortic valve gradients were also similar (12 mmHg vs. 11 mmHg, p = 0.48). Our study suggests that patients with EF \u2264 20% can safely have TAVR with similar periprocedural outcomes compared to patients with EF &gt; 20% to \u226440% despite higher rates of vasopressor and mechanical support.<\/jats:p>","DOI":"10.3390\/jcm12062390","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T05:46:42Z","timestamp":1679291202000},"page":"2390","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Periprocedural and Intermediate-Term Outcomes of TAVI in Patients with Ejection Fraction \u2264 20% vs. Patients with 20% &lt; EF \u2264 40%"],"prefix":"10.3390","volume":"12","author":[{"given":"Arber","family":"Kodra","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Cinelli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renita","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahming","family":"Hamfreth","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Staten Island University Hospital, Staten Island, NY 10305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denny","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shankar","family":"Thampi","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Basman","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chad","family":"Kliger","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Scheinerman","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Pirelli","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY 10075, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1001\/jamacardio.2018.4320","article-title":"Outcomes From Transcatheter Aortic Valve Replacement in Patients with Low-Flow, Low-Gradient Aortic Stenosis and Left Ventricular Ejection Fraction Less Than 30%: A Substudy From the TOPAS-TAVI Registry","volume":"4","author":"Ribeiro","year":"2019","journal-title":"JAMA Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1016\/j.jacc.2016.03.514","article-title":"Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement","volume":"67","author":"Baron","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.ahj.2016.08.009","article-title":"Rationale and design of the Transcatheter Aortic Valve Replacement to UNload the Left ventricle in patients with ADvanced heart failure (TAVR UNLOAD) trial","volume":"182","author":"Spitzer","year":"2016","journal-title":"Am. Heart J."},{"key":"ref_4","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/j.jcin.2019.01.233","article-title":"PARTNER Investigators. 1-Year Survival After TAVR of Patients with Low-Flow, Low-Gradient and High-Gradient Aortic Valve Stenosis in Matched Study Populations","volume":"12","author":"Renker","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4937","DOI":"10.1111\/jocs.17179","article-title":"Transcatheter heart valve selection in patients with low ejection fraction and aortic stenosis","volume":"37","author":"Mustafa","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1161\/CIRCINTERVENTIONS.113.000650","article-title":"Outcomes of transcatheter and surgical aortic valve replacement in high-risk patients with aortic stenosis and left ventricular dysfunction: Results from the Placement of Aortic Transcatheter Valves (PARTNER) trial (cohort A)","volume":"6","author":"Elmariah","year":"2013","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1016\/j.jacc.2020.11.018","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"77","author":"Otto","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e003425","DOI":"10.1161\/CIRCINTERVENTIONS.115.003425","article-title":"Early recovery of left ventricular systolic function after CoreValve transcatheter aortic valve replacement","volume":"9","author":"Dauerman","year":"2016","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"166","DOI":"10.4103\/jcecho.jcecho_13_18","article-title":"Early recovery of left ventricular systolic function after transcatheter aortic valve implantation","volume":"28","author":"Deste","year":"2018","journal-title":"J. Cardiovasc. Echogr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamacardio.2022.2222","article-title":"Association between Early Left Ventricular Ejection Fraction Improvement After Transcatheter Aortic Valve Replacement and 5-Year Clinical Outcomes","volume":"7","author":"Kolte","year":"2022","journal-title":"JAMA Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.amjcard.2019.10.059","article-title":"Effectiveness and Safety of Transcatheter Aortic Valve Implantation in Patients with Aortic Stenosis and Variable Ejection Fractions (<40%, 40%\u201349%, and >50%)","volume":"125","author":"Merdler","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/j.hrthm.2022.03.002","article-title":"Prognostic impact of permanent pacemaker implantation after transcatheter aortic valve replacement","volume":"19","author":"Sharobeem","year":"2022","journal-title":"Heart Rhythm."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/6\/2390\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:59:14Z","timestamp":1760122754000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/6\/2390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,20]]},"references-count":13,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["jcm12062390"],"URL":"https:\/\/doi.org\/10.3390\/jcm12062390","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,3,20]]}}}