Comparison of Right Ventricular Function Between Full Sternotomy Aortic Valve Replacement, Mini-Sternotomy Aortic Valve Replacement, and Transcatheter Aortic Valve Replacement: A Prospective, Observational Study.

BACKGROUND

The importance of right ventricular (RV) function assessment has been a hot topic in cardiac surgery, and perioperative RV function is known to determine the outcome of cardiac surgery. However, RV echocardiographic assessment is challenging due to RV geometric changes. Currently, a 3D-derived RV assessment is recommended. Previous studies have shown that RV function is reduced more in surgical aortic valve replacement (SAVR) than in transcatheter aortic valve replacement (TAVR); however, RV assessment in these studies was mostly performed using 2-dimensional echocardiography. Moreover, very few studies have assessed the difference in RV function between full sternotomy (full-SAVR) and mini-sternotomy AVR (mini-SAVR). This study assessed RV function in three types of AVR using 3D RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (RVFAC).

METHODS

This is a prospective, observational study at a university hospital setting. Participants are adult patients who underwent TAVR, mini-SAVR, and full-SAVR.

MEASUREMENTS AND MAIN

RESULTS

Sixty-seven patients were enrolled in this study (22, 22, and 23 patients in the TAVR, mini-SAVR, and full-SAVR groups, respectively). The % change (pre- and post-procedure) in 3D RVEF, RVFAC, and TPASE in TAVR, mini-SAVR, and full-SAVR were as follows: 3D RVEF: 4.51 ± 10.89 (TAVR), -13.67 ± 19.81 (mini-SAVR), and -8.36 ± 18.24 (full-SAVR) (p = 0.003).

RVFAC: 4.35 ± 12.33 (TAVR), -8.28 ± 23.88 (mini-SAVR), and -9.49 ± 20.92 (full-SAVR) (p < 0.001).

TAPSE: 10.46 ± 24.17 (TAVR), -22.14 ± 32.48 (mini-SAVR), and -32.48 ± 31.81 (full-SAVR) (p < 0.001). Comparisons were adjusted for age, gender, central venous pressure, catecholamine amount, and each preoperative RV index.

CONCLUSION

There was significantly more worsening of 3D RVEF, RVFAC and TAPSE after full-SAVR and mini-SAVR than after TAVR.