Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.
Heart. 2012 Sep;98(17):1299-304. doi: 10.1136/heartjnl-2011-301203. Epub 2012 Jun 11.
Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement (sAVR) in selected high risk patients. While improvement in left ventricular function after TAVI has been demonstrated, little is known about the impact on right ventricular (RV) function. Since postoperative RV dysfunction is linked to adverse outcomes, the authors sought to investigate the effect of TAVI and aortic valve replacement (AVR) on RV function using speckle tracking echocardiography.
Cross-sectional study in tertiary healthcare setting.
101 patients with severe symptomatic aortic stenosis (age 81 ± 11 yrs) who underwent TAVI and 22 patients who underwent sAVR were included. RV function was assessed using 2D longitudinal strain (RV-LS), fractional area change and tricuspid annular plain systolic excursion before and after sAVR and TAVI (median 89 days).
Although the TAVI group had worse baseline characteristics, RV function remained unchanged in this group whereas significant deterioration of RV function was observed in patients undergoing conventional AVR: RV-LS (-25.2 ± 6.1 vs -20.0 ± 7.0%; p=0.009), RV-fractional area change (47.0 ± 7.0 vs 39.8 ± 10.7%, p=0.019) and tricuspid annular plain systolic excursion (24 ± 5 vs 16 ± 4 mm, p=0.0001).
While TAVI did not affect RV function it deteriorated significantly in patients undergoing sAVR. The authors speculate that this may be related to the detrimental effects of pericardiotomy and, to a lesser degree, cardiopulmonary bypass. While further studies are required to assess the clinical significance of this finding, these data suggest that patients with pre-existing RV dysfunction may benefit from TAVI and that RV function should be incorporated into future risk scores.
经导管主动脉瓣植入术（TAVI）已成为某些高危患者主动脉瓣置换术（sAVR）的替代方法。虽然 TAVI 后左心室功能的改善已经得到证实，但关于右心室（RV）功能的影响却知之甚少。由于术后 RV 功能障碍与不良预后相关，作者试图使用斑点追踪超声心动图研究 TAVI 和主动脉瓣置换（AVR）对 RV 功能的影响。
三级医疗保健环境中的横断面研究。
纳入了 101 例患有严重症状性主动脉瓣狭窄（年龄 81±11 岁）的患者，他们接受了 TAVI 治疗，以及 22 例接受了 sAVR 的患者。使用二维纵向应变（RV-LS）、分数面积变化和三尖瓣环平面收缩期位移来评估 RV 功能，在 sAVR 和 TAVI 前后（中位数 89 天）进行评估。
尽管 TAVI 组的基线特征较差，但该组的 RV 功能仍保持不变，而接受传统 AVR 的患者的 RV 功能明显恶化：RV-LS（-25.2±6.1% 对-20.0±7.0%；p=0.009）、RV-分数面积变化（47.0±7.0% 对 39.8±10.7%，p=0.019）和三尖瓣环平面收缩期位移（24±5 对 16±4mm，p=0.0001）。
虽然 TAVI 对 RV 功能没有影响，但在接受 sAVR 的患者中明显恶化。作者推测，这可能与心包切开术的有害影响有关，在较小程度上也与体外循环有关。虽然需要进一步的研究来评估这一发现的临床意义，但这些数据表明，患有预先存在的 RV 功能障碍的患者可能受益于 TAVI，并且 RV 功能应纳入未来的风险评分。
