Acute Left Main Coronary Occlusion Following Transcatheter Aortic Valve Implantation

Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current world. The three cardinal signs of severe AS are dyspnea, syncope, and angina. Transcatheter aortic valve implantation is one of the safe and effective methods for treating severe aortic valve stenosis, and an alternative to surgery in high-risk patients. Aortic valve calcification and changes after TAVI were specifically assessed by computed tomography. Excessive aortic valve calcification is related to procedural complications. A possible consequence is obstruction of coronary ostia. Heavy calcification of the aortic valve and surrounding structure is an important risk factor for coronary obstruction, heart block, and embolization during aortic valve implantation (TAVI). Here we present a case of an elderly old man, where critical ostial left main coronary artery (LMCA) disease was caused by shifting of a calcium speck rather than obstruction with native leaflet. He was successfully rescued by an emergent CABG. Methods and Results: This is a case of a 69-year-old man with severe calcific aortic stenosis and single-vessel CAD who underwent TAVI with a relatively unremarkable course. Notably, his pre-operative TAVI angiography showed no LMCA stenosis. But 10 days later he presented to the ER with acute myocardial infarction with peak high-intensity troponins, diffuse ST changes, and cardiogenic shock. Urgent coronary angiography and intravascular ultrasound showed critical LMCA stenosis caused by a speck of calcium externally abating the vessel. He underwent emergency coronary artery bypass grafting;intraoperative TEE confirmed the etiology. He had an uneventful postoperative course and was successfully weaned off vasoactive medications. Conclusion: This case illustrates that obstruction of coronary ostia could be a possible complication of TAVI. Calcium distribution should factor in TAVI versus surgical candidacy. Calcium shifting should be watched closely during valve deployment, post-TAVI coronary angiogram should be considered if shifting was significant or suspected to compromise coronary arteries.

Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

Background Evaluation of patient outcomes following transcatheter aortic valve implantation （TAVI） has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days （range： 192-738 days）, five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.

Evaluation of CA125 and NT-proBNP values in patients undergoing transcatheter aortic valve implantation

Background Transcatheter aortic valve implantation （TAVI） is a minimally invasive, emerging therapy in surgically high risk, or in- operable patients. Parameters used for risk classification have some deficiencies in the selection of patients. The objective of this study is to evaluate the impact of TAVI on carbohydrate antigen 125 （CA125） and N-terminal pro brain-type natriuretic peptide （NT-proBNP） as biomarkers that have been used frequently in recent years, and also the relationship of these biomarkers to prognosis. Methods ＆ Results Transcatheter aortic valve implantation was practiced on 31 patients in this study. Then, CA125 and NT-proBNP levels studied in patients prior to and after the TAVI were evaluated. The patients were also grouped in accordance with their left ventrieular ejection fraction （LVEF） and CA125 levels （LVEF 〉 40% and 〈 40%; CA125 ≤ 35 U/L and 〉 35 U/L）. The TAVI operation was successfully performed in all patients. There was no in-hospital mortality and substantial improvement in functional capacity was detected at follow ups. In addition, a statistically significant decrease was detected in post-TAVI CA 125 and NT-proBNP levels of all patients （CA 125 83.8 ± 18.1 U/L vs. 64.3 ±14.2 U/L, P = 0.008; NT-proBNP： 4633.6± 627.6 pg/mL vs. 2866.3±536.8 pg/mL, P 〈 0.001）. In groups divided according to the CA125 levels, there was also statistically significant post-TAVI decline in CA125 levels. Within CA125 〉 35 U/L and LVEF 〈 40% groups, the permanent need for a pacemaker was required in one （3.2%） patient and mortality was observed in two （6.4%） patients after TAVI at follow up. Conclusions The results show that TAVI can be performed effectively and reliably in patients with high baseline levels of CA125 and NT-proBNP. These biomarkers are reduced substantially with TAVI, while high biomarker levels are associated with undesired events, and certainly, these biomarkers can be used for risk classifications in patient selection for TAVI.

Fluid-Structure Interaction in Problems of Patient Specific Transcatheter Aortic Valve Implantation with and Without Paravalvular Leakage Complication

Paravalvular Leakage(PVL)has been recognized as one of the most dangerous complications in relation to Transcathether Aortic Valve Implantation(TAVI)activities.However,data available in the literature about Fluid Structure Interaction(FSI)for this specific problem are relatively limited.In the present study,the fluid and structure responses of the hemodynamics along the patient aorta model and the aortic wall deformation are studied with the aid of numerical simulation taking into account PVL and 100%TAVI valve opening.In particular,the aorta without valve(AWoV)is assumed as the normal condition,whereas an aorta with TAVI 26 mm for 100%Geometrical Orifice Area(GOA)is considered as the patient aorta with PVL complication.A 3D patient-specific aorta model is elaborated using the MIMICS software.Implantation of the identical TAVI valve of Edward SAPIEN XT 26(Edwards Lifes ciences,Irvine,California)is considered.An undersized 26 mm TAVI valve with 100%valve opening is selected to mimic the presence of PVL at the aortic annulus.The present research indicates that the existence of PVL can increase the blood velocity,pressure drop and WSS in comparison to normal conditions,thereby paving the way to the development of recirculation flow,thrombus formation,aorta wall collapse,aortic rupture and damage of endothelium.

The role of echocardiography and CT angiography in transcatheter aortic valve implantation patients

The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echocardiography （TOE） and multislice CT （MSCT） constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional （2D） echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques （MSCT, MRI and 3D TOE）. Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.

Effect of transcatheter aortic valve implantation on QT dispersion in patients with aortic stenosis

Background QT dispersion （QTd） is a predictor of ventricular arrhythmia. Ventricular arrhythmia is an important factor influencing morbidity and mortality in patients with aortic stenosis. Surgical aortic valve replacement reduced the QTd in this patients group. However, the effect of transcatheter aortic valve implantation （TAVI） on QTd in patients with aortic stenosis is unknown. The aim of this study was to investigate the effect of TAVI on QTd in patients with aortic stenosis. Methods Patients with severe aortic stenosis, who were not candi-dates for surgical aortic valve replacement due to contraindications or high surgical risk, were included in the study. All patients underwent electrocardiographic and echocardiographic evaluation before, and at the 6th month after TAVI, computed QTd and left ventricular mass index （LVMI）. Results A total 30 patients were admitted to the study （mean age 83.2 ± 1.0 years, female 21 and male 9, mean valve area 0.7 ± 3 mm2）. Edwards SAPIEN heart valves, 23 mm （21 patients） and 26 mm （9 patients）, by the transfemoral approach were used in the TAVI procedures. All TAVI procedures were successful. Both QTd and LVMI at the 6th month after TAVI were significantly reduced com-pared with baseline values of QTd and LVMI before TAVI （73.8 ± 4 ms vs. 68 ± 2 ms, P=0.001 and 198 ± 51 g/m2 vs. 184 ± 40 g/m2, P=0.04, respectively）. There was a significant correlation between QTd and LVMI （r=0.646, P〈0.001）. Conclusions QTd, which malign ventricular arrhythmia marker, and LVMI were significantly reduced after TAVI procedure. TAVI may decrease the possibility of ventricu-lar arrhythmia in patients with aortic stenosis.

Transcatheter aortic valve implantation： a revolution in the therapy of elderly and high-risk patients with severe aortic stenosis

Transcatheter aortic valve implantation （TAV1） represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk surgical patients with severe symptomatic aortic valve stenosis. Today, TAVI seems to play a key and a reliable role in the treatment of intermediate and maybe low-risk patients with severe aortic stenosis. TAVI has also evolved from a complex and hazardous procedure into an effective and safe therapy by the development of new generation devices. This article aims to review the background and future of TAVI, elinieal trials and registries with old and new generation TAVI devices and to focus on some open issues related to post-procedural outcomes.

Long-term follow-up of quality of life in high-risk patients undergoing transcatheter aortic valve implantation for symptomatic aortic valve stenosis

Background Transcatheter aortic valve implantation （TAVI） has become the standard treatment for patients with severe symptomatic aortic stenosis （AS） considered at very high risk for surgical aortic valve replacement. The purpose of this sub-study was to evaluate long-term （〉 4 years） health-related quality of life （QoL） in octogenarians who underwent TAVI. Methods A single center observational registry in twenty patients who underwent frame analysis assessment ≥ 4 years after TAVI. Health-related QoL was evaluated, using the Short Form-36 （SF-36）, the EuroQoL-5D （EQ-5D） and the visual analogue score （EQ-VAS） questionnaires. Results The mean SF-36 subscale scores at follow-up were physical functioning 40.8 ± 26.3, role physical functioning 67.7 ± 34.9, vitality 54.6 ± 21.6, general health 52.1 ± 20.4, social functioning 63.8 ± 37.7, role emotional functioning 70.2 ± 36.0, mental health 73.2 ± 23.3 and bodily pain 80.9 ± 22.9. The mean EQ-VAS score 〉 4 years after TAVI was 64.7 ± 15.1. With respect to functional class, 80% of the patients were in NYHA class I/II at follow-up compared to 15% prior to TAVI. Conclusions This sub-study reports a significant improvement in functional class （NYHA） in a selected group of very elderly patients 〉 4 years after TAVI. Furthermore, all patients showed a satisfactory QoL despite their age and multiple comorbidities. In addition, our study reveals a lower QoL when compared with the general age matched Dutch population.

Impact of age on transcatheter aortic valve implantation outcomes：a comparison of patients aged≤ 80 years versus patients ＆gt; 80 years

ObjectiveTo investigate the procedural outcomes and the long-term survival of patients undergoing transcatheter aortic valve implantation （TAVI） and compare study results of patients≤ 80 years and patients ＆gt; 80 years old.MethodsA total of 240 patients treated with TAVI were divided into two groups according to age≤ 80 years （n = 105; 43.8%） and ＆gt; 80 years （n= 135; 56.2%）. The baseline characteristics and the pro-cedural outcomes were compared between these two groups of patients.ResultsWith the exception of peripheral artery disease and hypercho-lesterolemia, which were more frequently observed in the older age group, baseline characteristics were comparable between groups. Complica-tion rates did not differ significantly between patients≤ 80 years and patients ＆gt; 80 years. There were no differences in 30-day mortality rates be-tween patients aged≤ 80 years and patients ＆gt; 80 years old （9.5%vs. 7.4%, respectively;P = 0.557）. After a median follow-up of 28 months （in-terquartile range： 16-42 months）, 50 （47.6%） patients aged≤ 80 years died compared to 57 （42%） deaths in the group of patients ＆gt; 80 years old （P= 0.404）.ConclusionThe results of the present single center study showed that age did not significantly impact the outcomes of TAVI.

Defective recovery of QT dispersion following transcatheter aortic valve implantation： frequency, predictors and prognosis

Background Corrected QT dispersion （cQTD） has been correlated with non-uniform ventricular repolarisation and increased mortality. In patients with aortic stenosis, cQTD has been shown improved after surgical valve replacement, but the effects of transcatheter aortic valve implantation （TAVI） are unknown. Therefore, we sought to explore the frequency, predictors and prognostic effects of defective cQTD recovery at 6 months after TAVI. Methods A total of 222 patients underwent TAVI with the Medtronic-CoreValve System between November 2005 and January 2012. Patients who were on class Ⅰ or Ⅲ antiarrhythmics or on chronic haemodialysis or who developed atrial fibrillation, a new bundle branch block or became pacemaker dependent after TAVI were excluded. As a result, pre-, post- and follow-up ECG （median： 6 months） analysis was available in 45 eligible patients. Defective cQTD recovery was defined as any progression beyond the baseline cQTD at 6 months. Results In the 45 patients, the mean cQTD was 47 ± 23 ms at baseline, 45 ±17 ms immediately after TAVI and 40 ± 16 ms at 6 months （15% reduction, P = 0.049）. Compared to baseline, cQTD at 6 months was improved in 60% of the patients whereas defective cQTD recovery was present in 40%. cQTD increase immediately after TAVI was an independent predictor of defective cQTD recovery at 6 months （per 10 ms increase; OR： 1.89, 95% CI： 1.15-3.12）. By univariable analysis, defective cQTD recovery was associated with late mortality （HR： 1.52, 95% CI： 1.05-2.17）. Conclusions Despite a gradual reduction ofcQTD after TAVI, 40% of the patients had defective recovery at 6 months which was associated with late mortality. More detailed ECG analysis after TAVI may help to avoid late death.

Prognostic value of the ratio between prosthesis area and indexed annulus area measured by MultiSlice-CT for transcatheter aortic valve implantation procedures

Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT （MSCT） and the procedures were achieved using Edwards Sapien~ or Corevalve devices~. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups： normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium （VARC-2） endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve~. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker （PM） implantation rate was significantly higher in the severe oversizing group （P = 0.03）, while we observed more in-hospital congestive heart-failure （P = 0.02） in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation （AR） in the normal sizing group （P = 0.07）. Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.

Medical management of symptomatic severe aortic stenosis in patients non-eligible for transcatheter aortic valve implantation

1 Transcatheter aortic valve implantation in symptomatic severe aortic stenosis: where do we stand? Aortic stenosis occurs in 2%-9% of patients over the age of 65, the most common cause being degenerative.^([1,2]) The preferred treatment in symptomatic severe aortic stenosis(SAS) is surgical aortic valve replacement(SAVR), but in the elderly, the surgical risk can be greater than the benefit.([3]).

Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation

BACKGROUND Although transcatheter aortic valve implantation(TAVI)is a safe and effective treatment for aortic stenosis,it still carries some risks,such as valve leaks,stroke,and even death.The left ventricular global longitudinal strain(LVGLS)measurement may be useful for the prediction of adverse events during this operation.AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODS In this study,61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography.Before surgery,data on left ventricular ejection fraction(LVEF)and LVGLS were collected separately following balloon expansion and stent implantation.Difference in values of LVGLS and LVEF during preoperative balloon expansion(pre-ex),preoperative stent implantation(pre-im)and balloon expansion-stent implantation(ex-im)were also examined.Adverse events were defined as perioperative death,cardiac rupture,heart arrest,moderate or severe perivalvular leakage,significant mitral regurgitation during TAVI,perioperative moderate or severe mitral regurgitation,perioperative left ventricular outflow tract obstruction,reoperation,and acute heart failure.RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS,but not with difference in pre-ex LVEF.There were significant differences between pre-LVGLS and ex-LVGLS,and between pre-LVGLS and im-LVGLS(P=0.037 and P=0.020,respectively).However,differences in LVEF were not significant(P=0.358,P=0.254);however differences in pre-ex LVGLS were associated with pre-LVGLS(P=0.045).Compared to LVEF,LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period.Moreover,the differences in LVGLS were associated with the occurrence of perioperative adverse events,and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery.Furthermore,LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

Delayed right coronary ostial obstruction after J-valve deployment in transcatheter aortic valve implantation: A case report

BACKGROUND Aortic stenosis is the most common valve disease in adults.Transcatheter aortic valve implantation(TAVI)is being increasingly applied for intermediate-to lowrisk patients.Here,we describe an uncommon complication of delayed right coronary obstruction in a transapical TAVI case.CASE SUMMARY A 73-year-old woman with a EuroSCORE II of 1.21%underwent transapical TAVI because of severe aortic stenosis.The surgical procedure was uneventful.However,during routine monitoring after valve placement,the patient had a sudden onset of slow heart rate,the systolic blood pressure dropped sharply from 115 to 60 mmHg,and the central venous pressure abruptly increased from 10 to 33 cmH2O.The patient had a poor response to vasoactive agents.Transesophageal echocardiography revealed poor myocardial contractility,and electrocardiography showed a significant depression of ST-segment.Another angiography was performed immediately,which suggested complete obstruction of the right coronary artery.An emergency protocol was initiated.Cardiopulmonary bypass was established immediately.An aortic biological valve replacement under cardiopulmonary bypass was performed.CONCLUSION Perioperative monitoring,early recognition,and diagnosis of obstruction of coronary arteries in TAVI are important.Transesophageal echocardiography is a useful diagnostic and monitoring tool in this situation.Emergency protocols should be established during TAVI.

Change in quality of life after transcatheter aortic valve implantation and aortic valve replacement surgery in Australian patients aged ≥ 75 years： the effects of EuroSCORE and patient operability

Objective To determine the extent to which differences in generic quality of life （QOL） between transcatheter aortic valve implanta- tion （TAVI） and surgical aortic valve replacement （AVR） patients explained by EuroSCORE and heart-team operability assessment. Methods A total of 146 high-risk patients with EuroSCORE 〉 6 and aged 〉 75 years underwent TAVI （n = 80） or aortic valve replacement （n = 66） between February 2010 and July 2013. A total of 75 patients also completed preoperative and six month SF-12 QOL measures. Analyses examined incident major morbidity, compared six month QOL between groups adjusted for EUroSCORE and operability, and quantified rates of clinically significant QOL improvement and deterioration. Results The AVR group required longer ventilation （〉 24 h） （TAVI 5.0% vs. AVR 20.6%, P = 0.004） and more units of red blood cells [TAVI 0 （0-1） vs. AVR 2 （0-3）, P = 0.01]. New renal failure was higher in TAVI （TAVI 5.0% vs. AVR 0%, P = 0.06）. TAVI patients reported significantly lower vitality （P = 0.01） by comparison to AVR patients, however these findings were no longer significant after adjustment for operability. In both procedures, clinically significant QOL improvement was common [range 25.0% （general health） - 62.9% （physical role）] whereas deterioration in QOL occurred less frequently [range 9.3% （physical role） - 33.3% （mental health）]. Conclusions Clinically significant improvement and deterioration in QOL was evident at six months in high risk elderly aortic valve replacement patients. Overall QOL did not differ between TAVI and AVR once operability was taken into consideration.

A step forward parameter for the effects of transcatheter aortic valve implantation： transmural dispersion of repolarization

We read the article ＂Effect of transcatheter aortic valve implantation on QT dispersion in patients with aortic stenosis＂ by Erkan, et al. with great interest. In this study, they investigated the effect of transcatheter aortie valve implantation （TAVI） on QT dispersion （QTd） in patients with symptomatic severe aortic stenosis.

Impact of gender on outcomes after transcatheter aortic valve implantation

Backgound The influence of gender on clinical outcomes following transcatheter aortic valve implantation （TAVI） was considerably discrepant in previous studies. We aimed to investigate the impact of gender in our registry. Methods The study is a retrospective observational analysis of a prospectively designed cohort （546 consecutive patients treated at the University Hospital Zurich who were enrolled in Swiss TAVI Cohort from May 2008 to April 2014）. The Study took place in University Heart Centre at University Hospital Zurich, Switzerland. Results Both genders were equally represented with 51.5 % （n = 281） of the populations being females, who were significantly older and had a more pronounced history of hypertension （P 〈 0.001 ）. Males on the other hand showed a higher incidence of diabetes （P = 0.004）, coronary artery disease （P 〈 0.001）, chronic obstructive pulmonary disease （P 〈 0.001） and renal failure requiring renal replacement therapy （P = 0.018）. Patients were followed up for a median of 391 days with a 100% complete follow-up at one year. The primary outcome （all-cause mortality） occurred in 6.8% （n = 37） and 15% （n = 82） of patients at 30 days and one year, respectively. The 30-day all-cause mortality outcome did not significantly differ between females （7.5%） and males （6.0%） （P = 0.619）, but one year all-cause mortality occurred significantly more in males than in females （18.7% vs. 11.7%, P 〈 0.037）. Conclusion After TAVI implantation for severe aortic stenosis, males have a less favorable long-term （one year） mortality outcome than females.

Conduction abnormalities after transcatheter aortic valve implantation

In the last few years, transcatheter aortic valve implantation （TAVI） has become an alternative procedure in patients with severe aortic stenosis and high risk for surgical aortic replacement. Due to the anatomic correlation between aortic valve structure and conduction system of the heart, one of the most common complications after TAVI is conduction system disturbances which including bundle branch block, complete heart block and need for permanent pacemaker implantation. Although these disturbances are usually not lethal, they may have a great influence on patients＇ state and long term-survival. Several risk factors for conduction disturbances have been identified which including age, anatomy of the heart, periprocedural factors, type of implanted valve, preexisting abnormalities and comorbidities. As this technique becomes more familiar to physicians, patients should be carefully screened for risk factors for the development of conduction abnormalities after TAVI in order to provide effective prevention and proper treatment.

A centenarian transcatheter aortic valve implantation case

Aortic stenosis （AS） has become a leading cause of morbidity and mortality among a growing population of older adults. The number of elderly patients with severe symptomatic AS requiring aortic valve replacement has been significantly increasing in recent years.

Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation

Background Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation （TAVI） is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction （LVEF） on mortality after TAVI. Methods Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system （92.8%） or the Edwards SAPIEN valve system （7.2%）. Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF 〈 30% on mortality was assessed by Cox regression. Results Patients with LVEF 〈 30% （n = 63）, as compared to those with LVEF 〉 30% （n = 586）, had a higher prevalence of NHYA class 〉 2 （P 〈 0.001） and presented with a higher Euroscore （P 〈 0.001）. Procedural success was similar in both groups （98.4% vs. 97.2%, P = 1）. After a median follow-up of 436 days （25^-75th percentile, 357-737 days）, all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios （HR）： 0.96, 95% confidence intervals （CI）： 0.56-1.63] and cardiac mortality （19.1% vs. 17.6%, P = 0.89, HR： 1.04, 95% CI： 0.57-1.90） were similar in patients with LVEF 〈 30% as compared to those with LVEF 〉 30%. Thirty-day all-cause mortality was not significantly different between the two groups （11.1% vs. 6.3%, P = 0.14, HR： 1.81, 95% CI： 0.814.06）. Patients with LVEF 〈 30% had a trend toward higher risk of 30-day cardiac mortality （11.1% vs. 5.3%; P = 0.06, HR： 2.16, 95% CI： 0.95-4.90）, which disappeared after multivariable adjustment （P = 0.22）. Conclusions Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.