Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/89973
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Type: Journal article
Title: Early effects of transcatheter aortic valve implantation and aortic valve replacement on myocardial function and aortic valve hemodynamics: insights from cardiovascular magnetic resonance imaging
Author: Crouch, G.
Bennetts, J.
Sinhal, A.
Tully, P.
Leong, D.
Bradbrook, C.
Penhall, A.
De Pasquale, C.
Chakrabarty, A.
Baker, R.
Selvanayagam, J.
Citation: Journal of Thoracic and Cardiovascular Surgery, 2015; 149(2):462-470
Publisher: Mosby
Issue Date: 2015
ISSN: 0022-5223
1097-685X
Statement of
Responsibility: 
Gareth Crouch, Jayme Bennetts, Ajay Sinhal, Phillip J. Tully, Darryl P. Leong, Craig Bradbrook, Amy L. Penhall, Carmine G. De Pasquale, Adhiraj Chakrabarty, Robert A. Baker, Joseph B. Selvanayagam
Abstract: OBJECTIVES: There remains a paucity of mechanistic data on the effect of transcatheter aortic valve implantation (TAVI) on early left and right ventricular function and quantitative aortic valve regurgitation. We sought to assess and compare the early effects on myocardial function and aortic valve hemodynamics of TAVI and aortic valve replacement (AVR) using serial cardiovascular magnetic resonance (CMR) imaging and echocardiography. METHODS: A prospective comparison study of 47 patients with severe aortic stenosis undergoing either TAVI (n = 26) or high-risk AVR (n = 21). CMR (for left ventricle/right ventricle function, left ventricular mass, left atrial volume, and aortic regurgitation) was carried out before the procedure and early postprocedure (<14 days). RESULTS: Groups were similar with respect to Society of Thoracic Surgeons score (TAVI, 7.7 vs AVR, 5.9; P = .11). Preoperative left ventricular (TAVI, 69% ± 13% vs AVR, 73% ± 10%; P = .10) and right ventricular (TAVI, 61% ± 11% vs AVR, 59% ± 8%; P = .5) ejection fractions were similar. Postoperative left ventricular ejection fraction was preserved in both groups. In contrast, decline in right ventricular ejection fraction was more significant in the TAVI group (61%-54% vs 59%-58%; P = .01). Postprocedure aortic regurgitant fraction was significantly greater in the TAVI group (16% vs 4%; P = .001), as was left atrial size (110 vs 84 mL; P = .02). Further analysis revealed a significant relationship between the increased aortic regurgitant fraction and greater left atrial size (P = .006), and a trend toward association between the decline in right ventricle dysfunction and increased postprocedure aortic regurgitation (P = .08). CONCLUSIONS: There was no significant difference in early left ventricular systolic function between techniques. Whereas right ventricle systolic function was preserved in the AVR group, it was significantly impaired early after TAVI, possibly reflecting a clinically important pathophysiologic consequence of paravalvular aortic regurgitation.
Keywords: Aortic Valve
Humans
Aortic Valve Stenosis
Ventricular Dysfunction
Organometallic Compounds
Contrast Media
Image Interpretation, Computer-Assisted
Magnetic Resonance Imaging, Cine
Coronary Angiography
Echocardiography
Heart Function Tests
Treatment Outcome
Heart Valve Prosthesis Implantation
Prospective Studies
Aged
Aged, 80 and over
Female
Male
Hemodynamics
Cardiac Catheterization
Rights: © 2015 The American Association for Thoracic Surgery
DOI: 10.1016/j.jtcvs.2014.10.064
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