What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=87). Intervention: Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR). Primary outcome: Longitudinal left and right ventricular function (AVPD and PSV) (p=≤0.01).

April 1, 2013Open Access

Differences in recovery of left and right ventricular function following aortic valve interventions: A longitudinal echocardiographic study in patients undergoing surgical, transapical or transfemoral aortic valve implantation

Key Result

Transfemoral TAVI significantly improved longitudinal left ventricular function (p≤0.01) and preserved right ventricular function, whereas surgical replacement depressed right ventricular function.

Study Design

Type

Cohort (n=87)

Multicenter

Structured PICO

Does TAVI compared to SAVR, and TF-TAVI compared to TA-TAVI, improve longitudinal left and right ventricular function in patients undergoing aortic valve interventions?

Population

87 patients undergoing aortic valve interventions, including 60 TAVI patients (TF: n=35, TA: n=25; age 81 ± 7 years, logistic EuroSCORE 16 ± 10%) and 27 SAVR patients matched to 27 TAVI patients by age, gender, and LVF.

Intervention

Transcatheter aortic valve implantation (TAVI) via transfemoral (TF) or transapical (TA) approach

Comparator

Surgical aortic valve replacement (SAVR)

Outcome

Longitudinal left and right ventricular function (LVF and RVF) measured by echocardiography (atrioventricular plane displacement and peak systolic velocities) at 7 weeks and 6 months postprocedurallysurrogate

Transfemoral TAVI preserves longitudinal right ventricular function better than SAVR and improves early longitudinal left ventricular function compared to transapical TAVI.

Main Result

p-value: p=≤0.01

Limitations

Relatively small sample size precluding further subgroup analysis
Preprocedural differences in clinical characteristics between transfemoral and transapical TAVI patients
Essential unmatched differences in preinterventional clinical characteristics between SAVR and TAVI cohorts

Abstract

OBJECTIVES: To evaluate longitudinal left and right ventricular function (LVF and RVF) after transcatheter aortic valve implantation (TAVI) as compared to surgical aortic valve replacement (SAVR) and LVF and RVF after TAVI by the transfemoral (TF) or transapical (TA) approach. BACKGROUND: Knowledge about differences in recovery of LVF and RVF after TAVI and SAVR is scarce. METHODS: Sixty patients (age 81 ± 7 years, logistic EuroSCORE 16 ± 10%), undergoing TAVI (TF: n = 35 and TA: n = 25), were examined by echocardiography including atrioventricular plane displacement (AVPD) and peak systolic velocities (PSV) by tissue Doppler at basal RV free wall, LV lateral wall and septum preprocedurally, 7 weeks and 6 months postprocedurally. Twenty-seven SAVR patients were matched to 27 TAVI patients by age, gender and LVF. RESULTS: Early postintervention, TAVI patients had improved longitudinal LVF. However, when analyzed separately, only TF, but not TA patients, had improved LV lateral and septal AVPD and PSV (all P ≤ 0.01). All TAVI patients, as well as the TF and TA group had unchanged longitudinal LVF between the early and late follow-ups (all P > 0.05). The SAVR group had higher septal LVF than the matched TAVI group preprocedurally, while postoperatively this difference was diminished. Longitudinal RVF was better in the TF group than in the TA group pre- and postprocedurally. Although the SAVR group had superior longitudinal RVF preoperatively, this was inferior to TAVI postoperatively. CONCLUSIONS: Postprocedural longitudinal LVF and RVF in patients undergoing TF-TAVI, TA-TAVI, or SAVR differ considerably. Preservation of longitudinal RVF after TAVI might influence the selection of aortic valve intervention in the future.

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