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Background The increasing use of transcatheter aortic valve implantation (TAVI) in high-risk patients, especially those with ventricular dysfunction, justifies further evaluation of the selection and the results of the procedure. A database was used to characterize the profile of patients and evaluate TAVI results according to the degree of ventricular dysfunction. Methods This was a longitudinal observational study that included all patients with severe aortic stenosis (AoS) submitted to TAVI between 2009 and 2014, comparing those with left ventricular ejection fraction (LVEF) ≤ 40% vs. > 40%. The safety and efficacy outcomes were evaluated at 30 days and 1 year. Results Of the 172 patients, 20 (11.6%) had LVEF ≤ 40%. These patients were younger, with a higher prevalence of smoking, previous acute myocardial infarction, coronary artery bypass graft surgery, permanent pacemaker, and pulmonary artery hypertension. Higher functional classes were also more often observed in this group. The group with LVEF ≤ 40% had lower mean aortic valve gradient for an equivalent valve area. The procedure success did not differ between groups. There were no differences in mortality in coronary and cerebrovascular events, bleeding, vascular complications, and acute renal failure in the 30 day and 1 year follow-up. In the LVEF ≤ 40% group, the mean LVEF increased from 31.5 to 45.1% 1 year after the procedure (p = 0.002). Conclusions TAVI in patients with severe AoS and LVEF ≤ 40% does not increase the risk of complications and is associated with LVEF improvement.

Background Recent studies have demonstrated the efficacy of the transcatheter valve-in-valve implantation for the treatment of bioprosthesis dysfunction in high-risk surgical patients. This study presents the initial experience with valve-in-valve implantation. Methods Clinical, echocardiographic, and procedural profiles were characterized, and the mid-term results of patients with surgical bioprosthesis dysfunction submitted to valve-in-valve implantation in the aortic position were reported. Results Seven male patients were included, aged 72.6 ± 10.0 years. The STS score was 9,6 ± 10,5%, and the logistic EuroSCORE was 22.7 ± 14.7%. Three patients had combined aortic bioprosthesis failure; two had isolated regurgitation; and two had isolated stenosis. The transfemoral access was used in six cases, and the transapical access in one case. Implanted devices included Sapien XT (n = 5) and CoreValve (n = 2) prostheses. Procedural success was achieved in six (85.7%) cases. After the procedure, the mean gradient decreased from 38.2 ± 9.6 mmHg to 20.9 ± 5.9 mmHg, and the valve area increased from 1.2 ± 0.4 cm 2 to 1.5 ± 0.5 cm 2 . After 1 year, there were no deaths and no other significant adverse outcomes; 80% of patients were in NYHA functional class I/II. The transvalvular gradients and valve area remained unchanged in this period. Conclusions The valve-in-valve procedure was effective in most high-risk surgical patients with bioprosthesis dysfunction. When performed in well-selected patients, it results in satisfactory clinical and hemodynamic outcomes.

The presence of acute renal injury (AKI) enhances morbimortality after surgical aortic valve. However, the risk of periprocedural AKI and its association with outcomes after transcatheter aortic valve replacement (TAVR) is still incompletely understood. This prospective observational study aims to