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

Yonsei Medical Journal 2020년 61권 1호 p.30 ~ p.39

하상진(Ha Sang-Jin) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Internal Medicine
유상용(Yoo Sang-Yong) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Internal Medicine
홍명기(Hong Myeong-Ki) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
홍그루(Hong Geu-Ru) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology

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′ ratio (E/e′) and right ventricular systolic pressure (RVSP) decreased significantly in 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 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.