Aims Transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice in non-operable patients with severe symptomatic aortic stenosis. We sought to identify the clinical and echocardiographic predictors of short-term (30-day) and long-term (1-year) outcomes in patients with preserved or reduced left ventricular ejection fraction (LVEF) after TAVI.

Methods This single-center study included 618 consecutive aortic stenosis patients (mean age 82±6 years, 47.1% male; median EuroSCORE II 5.0%, quartiles 3.2-9.0%, 76.5% LVEF≥50%) who underwent TAVI between July 2009 and October 2018 in our hospital. Clinical and echocardiographic data were collected and analysed. All patients completed at least 6-months follow-up by medical history review or telephone interview (median 24, quartiles 12-42 months). The primary endpoint was defined as all-cause death.

Result Overall all-cause mortality was 45.1% (279/618). All-cause mortality at 30-day and 12-month were 5.2% (32/618) and 15.4% (95/618), respectively. Beside age, sex and BMI, the additional clinical covariates related to 30-day mortality included the use of amiodarone; while peripheral vascular disease, atrial fibrillation, the uses of amiodarone and antiplatelet drugs, and increased C-reactive protein level were revealed as additional clinical covariates of 12-month mortality. Risk factors related to overall mortality were peripheral vascular disease, atrial fibrillation, the use of amiodarone, increased urea and C-reactive protein levels. 

Left ventricular ejection fraction was similar between survivors and non-survivors in all three subgroups (57.7±13.3% vs. 56.9±11.7% p=0.454 at overall mortality, 57.5±12.5% vs. 54.7±14.0% p=0.225 at 30-day mortality, 57.5±12.9% vs. 56.5±11.1% p=0.453 at 12-month mortality). Further multivariable Cox regression analysis showed that lower TAPSE and septal MAPSE, higher septal E/e´ and sPAP were echocardiographic parameters related to increased risk of death post TAVI. In detail, septal E/e´≥28 remained as independent predictor of 30-day (HR 2.93, p=0.015), 12-month (HR 1.69, p=0.031), and overall mortality (HR 1.44, p=0.013) after adjustment for transapical approach, and aforementioned clinical confounders. Additionally, lower TAPSE (≤14mm, HR 1.35, p=0.041) and septal MAPSE (≤6mm, HR 1.37, p=0.018) were also independently associated with increased overall all-cause mortality after adjustment for transapical approach and clinical confounders. sPAP remained as an independent predictor of 30-day mortality post TAVI after adjustment for transapical approach and clinical confounders (5mmHg increase, HR 1.13, p=0.036). 

Conclusions LVEF is not a predictor of short and long-term mortality after TAVI. Therefore reduced LVEF should not prevent patients from undergoing TAVI. Left ventricular filling pressure (E/e´), systolic pulmonary artery pressure (sPAP), TAPSE and septal MAPSE represent risk factors for increased mortality post TAVI and should be assessed preinterventionally.