Right ventricular function after aortic valve replacement: a pilot study comparing surgical and transcatheter procedures using 3D echocardiography

Previous studies have found that standard echocardiographic measures of right ventricular (RV) function were impaired after surgical replacement of the aortic valve (SAVR), but not after transcatheter aortic valve implantation (TAVI). We used 3D echocardiography to gain further insight into the changes of RV performance in patient undergoing SAVR or TAVI. We conducted a prospective non-randomized study with two parallel groups and performed echocardiographic evaluation in 20 patients with aortic stenosis undergoing SAVR (age 77 ± 4 years), and in 20 patients undergoing TAVI via the transfemoral approach (age 83 ± 6 years) 1 week before and between the fifth and seventh day after the procedure. Tricuspid annular plane systolic excursion was postoperatively markedly reduced in patients undergoing SAVR (13 ± 2 vs 26 ± 4 mm, post- vs preoperative, P < 0.001), but not in patients undergoing TAVI (24 ± 7 vs 24 ± 5 mm, P = 0.90). Fractional shortening of the RV midcavity transverse diameter, however, increased after SAVR (50 ± 8 vs 31 ± 11%, P < 0.001) in contrast to TAVI (33 ± 10 vs 34 ± 9%, P = 0.85). The RV ejection fraction, assessed by 3D echocardiography, remained unchanged in both patient groups (SAVR, 55 ± 6 vs 55 ± 7%, P = 0.52; TAVI, 56 ± 8 vs 54 ± 7%, P = 0.28). RV longitudinal contraction decreased after SAVR, whereas RV transverse contraction increased. Both parameters did not change after TAVI. RV ejection fraction and RV stroke volume remained constant irrespective of the technique of aortic valve replacement, thus indicating that global systolic RV function is not compromised after SAVR.