Yonsei Med J.  2020 Jan;61(1):30-39. 10.3349/ymj.2020.61.1.30.

Immediate and Evolutionary Recovery of Left Ventricular Diastolic Function after Transcatheter Aortic Valve Replacement: Comparison with Surgery

• Ha SJ
• Yoo SY
• Hong MK
• Hong GR

• KMID: 2466333
• DOI: http://doi.org/10.3349/ymj.2020.61.1.30

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 patients with 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 patients undergoing sAVR (mean age, 78±3 years; male:female=12:15). We compared changes in the LV diastolic function and afterload before, 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 rapid improvement in diastolic filling patterns. E wave to e"² ratio (E/e"²) and right ventricular systolic pressure (RVSP) decreased significantly in the TAVR group (E/e"²: 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"², and RVSP were similar. Valvuloarterial impedance significantly decreased immediately after the procedure in both groups (TAVR, from 5.1±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 the sAVR 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 with sAVR. These results might explicate the remarkable clinical improvement in improvements in advanced diastolic dysfunction immediately after the TAVR procedure than sAVR.

Keyword

Transcatheter aortic valve replacement; aortic valve stenosis; diastolic function

MeSH Terms

Aortic Valve
Aortic Valve Stenosis
Blood Pressure
Echocardiography
Electric Impedance
Follow-Up Studies
Humans
Transcatheter Aortic Valve Replacement*

Figure

• 

  Fig. 1 Hemodynamic changes over time. (A) Serial change of aortic valve peak velocity. (B) Serial change of MSPG across the aortic valve. Error bars represent standard deviations, while the error bar of the left ventricular mass index represents the standard error. TAVR: transcatheter aortic valve replacement; sAVR: surgical aortic valve replacement; AVmax: peak AV velocity; MSPG: mean systolic pressure gradients; Pre: before the procedure; mo: months.

• 

  Fig. 2 Distribution of severity of diastolic function changes in TAVR and sAVR groups over time. Comparison between TAVR and sAVR at immediately after the procedure, p=0.018. Comparison between TAVR and sAVR at 3 months later, p=0.88. TAVR, transcatheter aortic valve replacement; sAVR, surgical aortic valve replacement; Pre, before the procedure.

• 

  Fig. 3 Changes in diastolic function parameters over time. (A) Serial change of E velocity. (B) Serial change of e′ velocity. (C) Serial change of E/e′ ratio. (D) Serial change of RVSP. The error bars represent one standard deviation. E/e′: E velocity to e′ ratio; RVSP: right ventricular systolic pressure; TAVR: transcatheter aortic valve replacement; sAVR: surgical aortic valve replacement; Pre: before the procedure; mo: months.

• 

  Fig. 4 Changes in afterload parameters over time. (A) Serial change of valvuloarterial impedance. (B) Serial change of SAC. (C) Serial change of SVR. Error bars represent one standard error. TAVR: transcatheter aortic valve replacement; sAVR: surgical aortic valve replacement; Zva: valvuloarterial impedance; SAC: systemic arterial compliance; SVR: systemic vascular resistance; Pre: before the procedure; mo: months.

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