Comparison of Right Ventricular Function Between Full Sternotomy Aortic Valve Replacement, Mini‐Sternotomy Aortic Valve Replacement, and Transcatheter Aortic Valve Replacement: A Prospective, Observational Study

Q: What does this research mean for the field?

Right ventricular function is significantly more impaired following both full-sternotomy and mini-sternotomy surgical aortic valve replacement compared with transcatheter aortic valve replacement. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yoshihisa Morita; Taro Kariya; Linda Sundt; Tomoki Sakata; Yuki Nakamura; Yuta Kikuchi; Daisuke Kaneyuki; Douglas S. Pfeil; Jacob Raphael

doi:10.1111/echo.70357

November 1, 2025EchocardiographyOpen Access

Comparison of Right Ventricular Function Between Full Sternotomy Aortic Valve Replacement, Mini‐Sternotomy Aortic Valve Replacement, and Transcatheter Aortic Valve Replacement: A Prospective, Observational Study

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Why the study?

Prior studies comparing right ventricular function after SAVR versus TAVR mostly used 2D echocardiography, and very few studies have evaluated right ventricular function differences between full sternotomy and mini-sternotomy AVR.

Does TAVR prevent perioperative right ventricular function worsening compared to mini-SAVR and full-SAVR in adult patients undergoing aortic valve replacement?

Key Points

To compare post-procedural right ventricular function among transcatheter aortic valve replacement, mini-sternotomy surgical replacement, and full-sternotomy surgical replacement using three-dimensional echocardiography.
Prospective, observational study conducted in an adult population at a university hospital.
Included 67 total patients undergoing transcatheter aortic valve replacement (n=22), mini-sternotomy aortic valve replacement (n=22), or full-sternotomy aortic valve replacement (n=23).
Measured pre- and post-procedure percentage changes in 3D right ventricular ejection fraction, fractional area change, and tricuspid annular plane systolic excursion, adjusting for baseline clinical variables.
Three-dimensional right ventricular ejection fraction changed by 4.51 ± 10.89% in TAVR compared to significant reductions of -13.67 ± 19.81% in mini-SAVR and -8.36 ± 18.24% in full-SAVR (p = 0.003).
Right ventricular fractional area change showed preservation in TAVR (4.35 ± 12.33%) but declined in mini-SAVR (-8.28 ± 23.88%) and full-SAVR (-9.49 ± 20.92%) (p < 0.001).
Tricuspid annular plane systolic excursion increased in TAVR (10.46 ± 24.17%) while decreasing in mini-SAVR (-22.14 ± 32.48%) and full-SAVR (-32.48 ± 31.81%) (p < 0.001).

Structured PICO

Does TAVR prevent perioperative right ventricular function worsening compared to mini-SAVR and full-SAVR in adult patients undergoing aortic valve replacement?

P

Population

67 adult patients who underwent aortic valve replacement (22 TAVR, 22 mini-SAVR, 23 full-SAVR) at a university hospital setting.

I

Intervention

Transcatheter aortic valve replacement (TAVR)

C

Comparator

Mini-sternotomy aortic valve replacement (mini-SAVR) and full sternotomy aortic valve replacement (full-SAVR)

O

Outcome

% change (pre- and post-procedure) in 3D RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (RVFAC)surrogate

Implication

TAVR is associated with better preservation of perioperative right ventricular function compared to both full and mini-sternotomy surgical aortic valve replacement.

Abstract

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Discussion

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Cite This Study

Morita et al. (2025) studied this question.

synapsesocial.com/papers/6a6fd64bc92390ac2d07ab43 https://doi.org/10.1111/echo.70357

Topics

TAVR in low-risk patients

Transcatheter aortic valve replacement

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Comparison of Right Ventricular Function Between Full Sternotomy Aortic Valve Replacement, Mini‐Sternotomy Aortic Valve Replacement, and Transcatheter Aortic Valve Replacement: A Prospective, Observational Study

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Topics

Comparison of Right Ventricular Function Between Full Sternotomy Aortic Valve Replacement, Mini‐Sternotomy Aortic Valve Replacement, and Transcatheter Aortic Valve Replacement: A Prospective, Observational Study

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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Topics

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