Right ventricular assessment in patients undergoing transcatheter or surgical aortic valve replacement

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is an alternative treatment option to surgical aortic valve replacement (SAVR) in selected high-risk patients. In this study, we aimed to evaluate the prognostic value of right ventricular (RV) functional imaging to predict clinical response to TAVR and SAVR. Methods: One hundred and ten patients with symptomatic severe aortic valve stenosis (AVS) undergoing successful TAVR and 32 controls undergoing SAVR were prospectively enrolled. Six months follow up (FU) included two-dimensional (2D) transthoracic echocardiography (TTE) with RV deformation imaging. Results: Baseline TTE showed no significant differences between groups (TAVR and SAVR) in conventional left ventricular (LV) and RV functional parameters (LV ejection fraction [LV-EF]: p =.21; tricuspidal annular plane systolic excursion [TAPSE]: 1.8 ± 0.5 cm, 1.9 ± 0.4 cm, p =.21), and RV strain (right ventricular-global longitudinal strain [RV-GLS] −11.6 ± 5.2%, −11.5 ± 6.5%, p =.70). At FU LV function was unchanged in both groups (p >.05); RV function was significantly improved after TAVR (RV-GLS: −11.6 ± 5.2%, −13.4 ± 6.1%, p =.005; TAPSE: 1.8 ± 0.5 cm, 1.9 ± 0.3 cm, p =.05), and worsened after SAVR (RV-GLS: −11.5 ± 6.5%, −8.9 ± 5.2%, p =.04; TAPSE: 1.9 ± 0.4 cm, 1.5 ± 0.3 cm, p