TAVR in Patients with Aortic Regurgitation with Low LVEF: Clinical Outcomes and the Value of ECMO

Background For patients with pure aortic regurgitation (AR) with low left ventricular ejection fraction (LVEF), the net clinical benefit of current treatment options remains uncertain. Our goal was to evaluate the clinical outcomes of TAVR in such patients and the periprocedural clinical value of extracorporeal membrane oxygenation (ECMO). Methods In this multicenter study, patients who underwent TAVR between June 2017 and May 2021 were enrolled. Patients were divided into three groups based on LVEF and whether they received preventive ECMO. The primary endpoint was 2-year all-cause mortality. Results A total of 751 patients were included, including 51 patients (6.8%) in the ECMO + LVEF < 35% group, 38 patients (5.1%) in the non-ECMO + LVEF < 35% group, and 662 patients (88.1%) in the non-ECMO + LVEF > 35% group. The three groups with LVEF were 26.0 (24.0–32.0)%, 33.0 (30.0–34.0)%, and 52.0 (48.0–57.0)%. The primary endpoint of patients with LVEF < 35% was similar to that of patients with LVEF > 35% (Hazard ratio: 1.18; 95% CI: 0.69–2.03, P  = 0.547). The 2-year LVEF of patients with LVEF < 35% was significantly increased. Notably, the ECMO + LVEF < 35% group had a lower incidence of the primary endpoint than the non-ECMO + LVEF < 35% group (hazard ratio: 0.47; 95% confidence interval: 0.17–0.82, P  = 0.042). Conclusions The 2-year clinical outcomes among the three groups were similar, and LVEF was significantly improved. Timely implantation of ECMO had potential clinical value for these patients.