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Aortic stenosis and the right heart at risk: is transcatheter aortic valve implantation the better option?
  1. Peter Wenaweser,
  2. Crochan J O'Sullivan
  1. Department of Cardiology, Bern University Hospital, Bern, Switzerland
  1. Correspondence to Dr. Peter Wenaweser, Professor of Cardiology, Department of Cardiology, University Hospital Bern, 3010 Bern, Switzerland; peter.wenaweser{at}insel.ch

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Recently transcatheter aortic valve implantation (TAVI) has been shown to be a safe and effective treatment for high-risk patients with severe symptomatic aortic stenosis (AS).1 ,2 In addition, it has been reported that TAVI is associated with better recovery of left ventricular (LV) ejection fraction (EF) compared with both medical treatment and surgical aortic valve replacement (SAVR).3 ,4 Little is known about the role of right ventricular (RV) function in patients undergoing TAVI. However, RV function is a major determinant of clinical outcomes following cardiac surgery.5–8 Indeed, SAVR itself (as well as cardiac surgery in general), is well-known to precipitate RV dysfunction (table 1), although the mechanisms underlying this phenomenon remain poorly understood.9–13 Unlike LVEF and pulmonary hypertension, however, variables of RV function have yet to be incorporated into large-scale risk stratification models such as the Society for Thoracic Surgeons' risk model and the European System for Cardiac Operative Risk Evaluation. This is partly related to the fact that non-invasive functional assessment of the RV is difficult owing to the complex geometry of the RV chamber.14 Because RV dysfunction associated with SAVR can lead to adverse clinical sequelae,5 ,6 it is timely that the relationship between TAVI and RV-function is now beginning to be elucidated.

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Table 1

Cardiac surgery and RV function …

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