Transfemoral AVI preserved right ventricular function (TAPSE unchanged, P=0.38), whereas transapical AVI and SAVR caused significant deterioration in TAPSE (P=0.02 and P>0.001, respectively).
Observational (n=225)
Does transcatheter aortic valve implantation (transfemoral or transapical) preserve early postoperative right and left ventricular function better than surgical aortic valve replacement in patients with severe aortic stenosis?
Transfemoral TAVI preserves early postoperative right ventricular function better than transapical TAVI and surgical aortic valve replacement, likely due to less intraoperative trauma.
BACKGROUND: While impact of surgical aortic valve replacement (SAVR) on the function of the right and left ventricle (RV, LV) has been studied extensively, the objective of this study was to compare the two different transcatheter approaches, transfemoral vs. transapical aortic valve implantation (tf-AVI, ta-AVI) and SAVR with respect to postoperative recovery of RV and LV function in patients with severe aortic stenosis. METHODS AND RESULTS: Conventional echocardiographic studies were performed before and after the procedure ( 0.001) and ta-AVI (21.1 +/- 4.7 mm vs. 19.1 +/- 4.7 mm, P = 0.02), while TAPSE remained unchanged in the tf-AVI group (21.7 +/- 5 mm vs. 22.1 +/- 4.9 mm, P = 0.38). Additionally, a significant drop of the visually estimated right ventricular ejection fraction in the SAVR and ta-AVI group compared to tf-AVI could be seen (P < 0.001, P = 0.003, respectively) Among patients with a pre-existing reduced LV-function, despite similar baseline LVEF (38.5 +/- 7.1% vs. 37.4 +/- 5.6, P = 0.8), tf-AVI patients had better recovery of LVEF compared with ta-AVI (ALVEF 7.2 +/- 8% vs. 1.6 +/- 9.3%, P = 0.038). CONCLUSION: Our study underlines the less invasive nature of tf-AVI, causing less intraoperative trauma and pericardial adhesions to the heart. Given that acute RV failure after cardiac surgery remains a major cause of morbidity and mortality, the results of the present study suggest that in high-risk patients, TAVI and in particular tf-AVI could be favoured over SAVR in regard to a RV dysfunction.
Quick et al. (2013) conducted an observational in Severe aortic stenosis (n=225). Transfemoral and transapical aortic valve implantation (tf-AVI, ta-AVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on Postoperative recovery of right and left ventricular function (TAPSE). Transfemoral AVI preserved right ventricular function (TAPSE unchanged, P=0.38), whereas transapical AVI and SAVR caused significant deterioration in TAPSE (P=0.02 and P>0.001, respectively).