Left and right ventricular function in aortic stenosis patients 8 weeks post-transcatheter aortic valve implantation or surgical aortic valve replacement.

Abstract

Knowledge of longitudinal left and right ventricular (LV and RV) function after transcatheter aortic valve implantation (TAVI) is scarce. We hypothesized that the longitudinal systolic biventricular function in aortic stenosis (AS) patients is affected differently by TAVI and surgical aortic valve replacement (SAVR). Thirty-three AS patients (all-TAVI group, age 81 ± 9 years, 18 female), with EuroSCORE 18 ± 9%, were accepted for TAVI. Seventeen of these patients were matched (by gender, age, and LV function) to 17 patients undergoing SAVR. Conventional echocardiographic parameters, systolic atrioventricular plane displacement (AVPD) at standard sites and peak systolic velocity (PSV) by pulsed tissue Doppler at basal RV free wall, LV lateral wall, and septum were studied before and 8 weeks after the procedure. Procedural success was 100%, and 30-day mortality 9%. In all TAVI patients, AVPD_lateral, PSV_lateral, AVPD_septal, and PSV_septal increased (P< 0.001, 0.003, 0.006 and 0.002). When studying the matched patients postoperatively, both the SAVR and TAVI patients had increased PSV_lateral and AVPD_lateral (SAVR: P=0.03 and P=0.04, TAVI: P=0.04 and P=0.01). The PSV_RV increased in the all-TAVI group (P=0.007), while the AVPD_RV was unchanged. SAVR patients had decreased AVPD_RV (P=0.001) and PSV_RV (P=0.004), while the matched TAVI patients had unchanged RV function parameters. An improvement in regional longitudinal LV function in the septal and lateral wall could be seen after TAVI. Among the matched patients, both the TAVI and SAVR patients seemed to improve LV function in the lateral wall. RV systolic function increased in TAVI patients, but was impaired in the matched SAVR group at the 8-week follow-up.