Impact of transcatheter aortic valve implantation or surgical aortic valve replacement on right ventricular function
- Aleksander Kempny1,
- Gerhard-Paul Diller1,
- Gerrit Kaleschke1,
- Stefan Orwat1,
- Angela Funke1,
- Renate Schmidt1,
- Gregor Kerckhoff1,
- Farshad Ghezelbash1,
- Andreas Rukosujew2,
- Holger Reinecke1,
- Hans H Scheld2,
- Helmut Baumgartner1
- 1Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany
- 2Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany
- Correspondence to Professor Helmut Baumgartner, Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany;
Contributors All authors have read and approved the manuscript. All authors have also sufficiently contributed to conception and design of the study, analysis and interpretation of data, drafting of the manuscript or revising it to justify authorship.
- Accepted 8 May 2012
- Published Online First 11 June 2012
Objective Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement (sAVR) in selected high risk patients. While improvement in left ventricular function after TAVI has been demonstrated, little is known about the impact on right ventricular (RV) function. Since postoperative RV dysfunction is linked to adverse outcomes, the authors sought to investigate the effect of TAVI and aortic valve replacement (AVR) on RV function using speckle tracking echocardiography.
Design Cross-sectional study in tertiary healthcare setting.
Setting 101 patients with severe symptomatic aortic stenosis (age 81±11 yrs) who underwent TAVI and 22 patients who underwent sAVR were included. RV function was assessed using 2D longitudinal strain (RV-LS), fractional area change and tricuspid annular plain systolic excursion before and after sAVR and TAVI (median 89 days).
Results Although the TAVI group had worse baseline characteristics, RV function remained unchanged in this group whereas significant deterioration of RV function was observed in patients undergoing conventional AVR: RV-LS (−25.2±6.1 vs −20.0±7.0%; p=0.009), RV-fractional area change (47.0±7.0 vs 39.8±10.7%, p=0.019) and tricuspid annular plain systolic excursion (24±5 vs 16±4 mm, p=0.0001).
Conclusion While TAVI did not affect RV function it deteriorated significantly in patients undergoing sAVR. The authors speculate that this may be related to the detrimental effects of pericardiotomy and, to a lesser degree, cardiopulmonary bypass. While further studies are required to assess the clinical significance of this finding, these data suggest that patients with pre-existing RV dysfunction may benefit from TAVI and that RV function should be incorporated into future risk scores.
- Cardiac function
- congenital heart disease
- pericardial disease
- valvular disease
- imaging and diagnostics
- heart failure
- interventional cardiology
- percutaneous valve therapy
Funding The Adult Congenital and Valvular Heart Disease Center, University Hospital of Muenster has received support by the EMAH Foundation Karla Voellm, Krefeld, Germany. AK was supported by the Deutsche Herzstiftung e.V.
Competing interests HB acts as a consultant and proctor for ‘Edwards Lifesciences’; all the other authors have no disclosures. For HB, the ICMJE form will be uploaded.
Ethics approval The ethics approval was provided by the Research Ethics Committee, University of Muenster, Germany.
Provenance and peer review Not commissioned; internally peer reviewed.