Key result
Minimally invasive AVR preserves RV longitudinal strain rate compared to conventional surgery.
Why the study?
Minimally invasive aortic valve replacement surgery (MIAVR) is an alternative to conventional AVR, but differences in right ventricular mechanics and contractility post-surgery remain unclear.
Does minimally invasive aortic valve replacement surgery improve right ventricular mechanics and contractility compared to conventional aortic valve replacement in patients with severe aortic valve stenosis?
RCT (n=40)
Open-label
1:1
No
Does minimally invasive aortic valve replacement surgery improve right ventricular mechanics and contractility compared to conventional aortic valve replacement in patients with severe aortic valve stenosis?
Absolute Event Rate: -1.5% vs -1.4%
p-value: p=0.53
Minimally invasive aortic valve replacement preserves right ventricular contractility and results in a smaller decline in RV longitudinal function compared to conventional AVR at 40 days post-surgery.
Minimally invasive aortic valve replacement better preserves right ventricular strain than conventional surgery; extends prior observational data with randomized evidence.
Objective: Minimally invasive aortic valve replacementsurgery (MIAVR) is an alternative surgical technique to conventional aortic valve replacement surgery (AVR) in selected patients. The randomised study Cardiac Function after Minimally Invasive Aortic Valve Implantation (CMILE) showed that right ventricular (RV) longitudinal function was reduced after both MIAVR and AVR, but the reduction was more pronounced following AVR. However, postoperative global RV function was equally impaired in both groups. The purpose of this study was to explore alterations in RV mechanics and contractility following MIAVR as compared with AVR. Methods: A predefined post hoc analysis of CMILE consisting of 40 patients with severe aortic valve stenosis who were eligible for isolated surgical aortic valve replacement were randomised to MIAVR or AVR. RV function was assessed by echocardiography prior to surgery and 40 days post-surgery. Results: Comparing preoperative to postoperative values, RV longitudinal strain rate was preserved following MIAVR (-1.5±0.5 vs -1.5±0.4 1/s, p=0.84) but declined following AVR (-1.7±0.3 vs -1.4±0.3 1/s, p<0.01). RV longitudinal strain reduced following AVR (-27.4±2.9% vs -18.8%±4.7%, p<0.001) and MIAVR (-26.5±5.3% vs -20.7%±4.5%, p<0.01). Peak systolic velocity of the lateral tricuspid annulus reduced by 36.6% in the AVR group (9.3±2.1 vs 5.9±1.5 cm/s, p<0.01) and 18.8% in the MIAVR group (10.1±2.9 vs 8.2±1.4 cm/s, p<0.01) when comparing preoperative values with postoperative values. Conclusions: RV contractility was preserved following MIAVR but was deteriorated following AVR. RV longitudinal function reduced substantially following AVR. A decline in RV longitudinal function was also observed following MIAVR, however, to a much lesser extent.
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Hashemi et al. (2018) conducted an RCT in Severe aortic valve stenosis (n=40). Minimally invasive aortic valve replacement surgery (MIAVR) vs. Conventional aortic valve replacement surgery (AVR) was evaluated on Right ventricular longitudinal strain rate (RV-LSR) at 40 days post-surgery (1/s) (p=0.53). Minimally invasive aortic valve replacement preserved right ventricular longitudinal strain rate (-1.5 1/s pre to -1.5 1/s post, p=0.84) compared to a significant decline following conventional surgery (-1.7 1/s pre to -1.4 1/s post, p<0.01).
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