Aortic stenosis: right and left ventricular function in the early postprocedural phase. Comparison between transcatheter and surgical aortic valve implantation.

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 (< 8 days) in 74 consecutive patients undergoing tf-AVI, 88 with ta-AVI and 63 surgically treated patients. Post procedure, a marked deterioration in the tricuspid annular plane systolic excursion (TAPSE) was seen after SAVR (23.7 +/- 4 mm vs. 15.6 +/- 2.9 mm, P > 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.