Transcatheter aortic valve replacement in patients with reduced left ventricular ejection fraction

Introduction. The risk of endovascular interventions in various forms of cardiac pathology is significantly lower than in surgical correction of similar conditions under cardiopulmonary bypass.

The aim of the study was to evaluate the dynamics of key indicators of central hemodynamics following transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and reduced left ventricular contractile function.

Materials and methods: 22 TAVI procedures were performed (13 men and 9 women) in patients with severe aortic stenosis combined with severe systolic dysfunction of the left ventricle. The functional class of heart failure according to NYHA was: Class III - 15 patients, Class IV - 7 patients. The average age was 65.6±2.18 years (ranging from 44 to 78 years).

Results. On average, there was a 30% increase in the left ventricular ejection fraction (LVEF) from 27.5 ± 2.9% to 41.2 ± 6.1% (P<0.001). There was a significant decrease in left ventricular volume. The left ventricular end-diastolic volume decreased from 176.3 ± 54.2 ml to 140.4 ± 40.1 ml (P<0.001). A significant improvement in central hemodynamics was confirmed by a substantial reduction in pulmonary artery pressure, which approached normal values - 34.3 ± 1.3 mmHg, compared to the initial value of 65±2.4 mmHg (P<0.001). The results of TAVI in patients with severe systolic dysfunction of the left ventricle demonstrate a radical improvement in cardiac performance. The degree of change in central hemodynamic parameters after the elimination of aortic stenosis reflects the level of myocardial functional reserve and may serve as a real criterion for determining of the prognosis of the disease.

Conclusion: Data from instrumental investigations performed in the postoperative period indicate a high level of technical and clinical success in performing TAVI in patients with reduced left ventricular contractile function.

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