Immediate and Evolutionary Recovery of Left Ventricular Diastolic Function after Transcatheter Aortic Valve Replacement: Comparison with Surgery
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Purpose: We aimed to compare the effect of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement(sAVR) on recovery of left ventricular (LV) diastolic function and afterload through serial echocardiographic examinations in patientswith symptomatic high-risk severe aortic stenosis during early follow-up. Materials and Methods: We included 38 patients undergoing TAVR (mean age, 80±6 years; male:female=18:20) and 27 patientsundergoing sAVR (mean age, 78±3 years; male:female=12:15). We compared changes in the LV diastolic function and afterloadbefore, immediately after, and 3 months after the procedure using serial transthoracic echocardiography. Results: Immediately after the procedure, 16 (42%) and 3 (11%) patients in the TAVR and sAVR groups, respectively, showed rapidimprovement in diastolic filling patterns. E wave to e' ratio (E/e') and right ventricular systolic pressure (RVSP) decreased significantlyin the TAVR group (E/e': TAVR, from 24.6±12.9 to 20±9.5, p=0.048 vs. sAVR, from 21.5±9.4 to 20.64±6.4, p=0.361; RVSP: TAVR,38.4±17.2 vs. 34±12.4, p=0.032 vs. sAVR, 32.2±11.7 vs. 30±6.8, p=0.27). After 3 months, diastolic grade distribution, E/e', and RVSPwere similar. Valvuloarterial impedance significantly decreased immediately after the procedure in both groups (TAVR, from5.1±1.4 to 3.1±1.0 vs. sAVR, from 4.5±1.5 to 3.1±0.8 mm Hg . mL−1 . m−2, p=0.001), but after 3 months, decreases were greater in thesAVR group (from 3.1±0.8 to 2.2±1.5 mm Hg . mL−1 . m−2, p=0.093). Conclusion: LV diastolic function improved more rapidly and earlier in patients treatment with TAVR than in patients treated withsAVR. These results might explicate the remarkable clinical improvement in improvements in advanced diastolic dysfunction immediatelyafter the TAVR procedure than sAVR.
Abstract
Purpose: We aimed to compare the effect of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement(sAVR) on recovery of left ventricular (LV) diastolic function and afterload through serial echocardiographic examinations in patientswith symptomatic high-risk severe aortic stenosis during early follow-up. Materials and Methods: We included 38 patients undergoing TAVR (mean age, 80±6 years; male:female=18:20) and 27 patientsundergoing sAVR (mean age, 78±3 years; male:female=12:15). We compared changes in the LV diastolic function and afterloadbefore, immediately after, and 3 months after the procedure using serial transthoracic echocardiography. Results: Immediately after the procedure, 16 (42%) and 3 (11%) patients in the TAVR and sAVR groups, respectively, showed rapidimprovement in diastolic filling patterns. E wave to e' ratio (E/e') and right ventricular systolic pressure (RVSP) decreased significantlyin the TAVR group (E/e': TAVR, from 24.6±12.9 to 20±9.5, p=0.048 vs. sAVR, from 21.5±9.4 to 20.64±6.4, p=0.361; RVSP: TAVR,38.4±17.2 vs. 34±12.4, p=0.032 vs. sAVR, 32.2±11.7 vs. 30±6.8, p=0.27). After 3 months, diastolic grade distribution, E/e', and RVSPwere similar. Valvuloarterial impedance significantly decreased immediately after the procedure in both groups (TAVR, from5.1±1.4 to 3.1±1.0 vs. sAVR, from 4.5±1.5 to 3.1±0.8 mm Hg . mL−1 . m−2, p=0.001), but after 3 months, decreases were greater in thesAVR group (from 3.1±0.8 to 2.2±1.5 mm Hg . mL−1 . m−2, p=0.093). Conclusion: LV diastolic function improved more rapidly and earlier in patients treatment with TAVR than in patients treated withsAVR. These results might explicate the remarkable clinical improvement in improvements in advanced diastolic dysfunction immediatelyafter the TAVR procedure than sAVR.
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