Key result
Transcatheter aortic valve replacement resulted in a significantly larger increase in distal aortic global circumferential strain compared to surgical aortic valve replacement (median delta GCS 2.8% vs 0.15%, p<0.001).
Why the study?
Biomechanical effects of TAVR versus SAVR on the distal aorta had not been studied.
Does transcatheter aortic valve replacement increase global circumferential strain in the distal aorta compared to surgical aortic valve replacement in patients with severe aortic stenosis?
Cohort (n=80)
Single-blind
No
Does transcatheter aortic valve replacement increase global circumferential strain in the distal aorta compared to surgical aortic valve replacement in patients with severe aortic stenosis?
TAVR is associated with a significantly larger acute increase in global circumferential strain in the distal aorta compared to SAVR, suggesting increased energy propagation that may impact long-term aortic remodeling.
Answers are grounded in this paper and cite their sources.
Larger distal aortic GCS rise after TAVR may affect remodeling; hypothesis-generating and should not yet alter valve choice.
BACKGROUND: Biomechanical effects of transcatheter (TAVR) versus surgical (SAVR) aortic valve interventions on the distal aorta have not been studied. This study utilized global circumferential strain (GCS) to assess post-procedural biomechanics changes in the descending aorta after TAVR versus SAVR. METHODS: Patients undergoing TAVR or SAVR for aortic stenosis were included. Transesophageal (TEE) and transthoracic (TTE) echocardiography short-axis images of the aorta were used to image the descending aorta immediately before and after interventions. Image analysis was performed with two-dimensional speckle tracking echocardiography and dedicated software. Delta GCS was calculated as: post-procedural GCS-pre-procedural GCS. Percentage delta GCS was calculated as: (delta GCS/pre-procedural GCS) × 100. RESULTS: Eighty patients, 40 TAVR (median age 81 y/o, 40% female) and 40 SAVR (median 72 y/o, 30% female) were included. The post-procedure GCS was significantly higher than the pre-procedural GCS in the TAVR (median 10.7 [interquartile range IQR 4.5, 14.6] vs. 17.0 [IQR 6.1, 20.9], p = 0.009) but not in the SAVR group (4.4 [IQR 3.3, 5.3] vs. 4.7 [IQR 3.9, 5.6], p = 0.3). The delta GCS and the percentage delta GCS were both significantly higher in the TAVR versus SAVR group (2.8% [IQR 1.4, 6] vs. 0.15% [IQR - 0.6, 1.5], p < 0.001; and 28.8% [IQR 14.6%, 64.6%] vs. 4.4% [IQR - 10.6%, 5.6%], p = 0.006). Results were consistent after multivariable adjustment for key clinical and hemodynamic characteristics. CONCLUSIONS: After TAVR, there was a significantly larger increase in GCS in the distal aorta compared to SAVR. This may impact descending aortic remodeling and long-term risk of aortic events.
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Rong et al. (2023) conducted a cohort in Severe isolated aortic stenosis (n=80). Transcatheter aortic valve replacement vs. Surgical aortic valve replacement was evaluated on Change in global circumferential strain (delta GCS) (p=<0.001). Transcatheter aortic valve replacement resulted in a significantly larger increase in distal aortic global circumferential strain compared to surgical aortic valve replacement (median delta GCS 2.8% vs 0.15%, p<0.001).
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