Outcomes after transcatheter aortic valve replacement in patients with severe aortic stenosis and diastolic dysfunction

Objectives: Left ventricular diastolic dysfunction (LVDD) in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with poor outcomes; however, the effect of its severity is controversial. We sought to assess the impact of diastolic dysfunction on hospital outcomes and survival after TAVR and identify prognostic factors. Methods: We included patients who underwent TAVR for severe aortic stenosis with preexisting LVDD from 2009 to 2018 (n ¼ 325). Patients with prior mitral valve surgery (n ¼ 4), atrial fibrillation (n ¼ 39), missing or poor baseline diastolic dysfunction assessment (n ¼ 36) were excluded. The primary endpoint was all-cause mortality. 246 patients were included in the study. Results: The median age was 80 years (25th and 75th percentiles:75e86.7), 154 (62.6%) were males and the median EuroSCORE II was 4.3 (2.2e8). Patients with severe LVDD had significantly higher EuroSCORE, and lower ejection fraction (p < 0.001). There was no difference in post-TAVR new atrial fibrillation (p ¼ 0.912), pacemaker insertion (p ¼ 0.528), stroke (p ¼ 0.76), or hospital mortality (p ¼ 0.95). Patients with severe LVDD had longer hospital stay (p ¼ 0.036). The grade of LVDD did not affect survival (log-rank ¼ 0.145) nor major adverse cardiovascular events (log-rank ¼ 0.97). Predictors of mortality were; low BMI (HR: 0.95 (0.91e0.99); p ¼ 0.019), low sodium (0.93 (0.82e2.5); p ¼ 0.021), previous PCI (HR: 1.6 (1.022e2.66); p ¼ 0.04), E-peak (HR: 1.01 (1.002e1.019); p ¼ 0.014) and implantation of more than one device (HR: 3.55 (1.22e10.31); p ¼ 0.02). Conclusion: Transcatheter aortic valve replacement is feasible in patients with diastolic dysfunction, and the degree of diastolic dysfunction did not negatively affect the outcome. Long-term outcomes in those patients were affected by the preoperative clinical state and procedure-related factors.