RV DYSFUNCTION IN TRANS-CATHETER AORTIC VALVE REPLACEMENT

BACKGROUND:

Aortic stenosis patients might also suffer from right ventricular (RV) dysfunction and tricuspid regurgitation. Studies in the past have tried to examine the impact of trans-catheter aortic valve replacement (TAVR) on patients with these conditions. We used the new "Redcap" Israeli multi-center database to examine the outcomes in these patients following TAVR.

METHODS:

A retrospective analysis was conducted of baseline clinical and echocardiographic characteristics, 1-month echocardiographic follow-up and all-cause mortality in 4334 TAVR patients.

RESULTS:

478 (11%) patients had TR which was moderate and above. 202 (4.6%) patients had any degree of RV dysfunction. The mean SPAP at baseline was 40.2 mmHg (±16.7). At 1-month echocardiographic follow-up there was no difference in TR degree (p=0.95) and no difference in RV dysfunction degree (0.07). There was a decrease in SPAP to 38.3±16.1 mmHg (p<0.001). All-cause mortality was increased over a 5 year period for patients with higher grades of TR (Log-rank Chi-square 47.5, p<0.001) and higher grades of RV dysfunction (Log-rank Chi-square 24.0, p<0.001). The results remained statistically significant when adjusted for clinical and echocardiographic baseline differences using a Cox-regression model.

CONCLUSIONS:

Only a minority of Aortic Stenosis patients has severe TR or RV dysfunction. Although a small decrease in SPAP is seen after TAVR, there is no change in RV dysfunction or TR severity after procedure. Patients with a more severe TR or RV dysfunction at base are independently at a higher risk of long-term all-cause mortality.