Comparative study of transcatheter aortic valve implantation versus conventional surgical aortic valve replacement in the treatment of severe aortic stenosis with reverse ventricular remodeling.

INTRODUCTION: This study aimed to compare echocardiographic outcomes and analyze the changes in ventricular remodeling at different time points after surgery in patients with severe aortic stenosis (AS) undergoing either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).

METHODS: This retrospective study consecutively enrolled 175 patients with severe AS who underwent either SAVR or TAVR. Transthoracic echocardiograms obtained at baseline, 30 days, and 1 year after the procedure were analyzed by multiple echocardiographers at our institution.

RESULTS: At baseline, the TAVR group was significantly older (74 ± 7 years vs. 62 ± 9 years, p < 0.001) and had a higher prevalence of hypertension (53.5% vs. 31.0%, p = 0.003), coronary artery disease (38.4% vs. 23.0%, p = 0.028), and atrial fibrillation (16.3% vs. 2.3%, p = 0.002). Additionally, the TAVR cohort demonstrated significantly worse cardiac functional status (p < 0.001). Compared to TAVR patients, SAVR patients (N = 87) exhibited a more pronounced reduction in left ventricular end-systolic dimension (-0.5 ± 0.65 cm vs. -0.2 ± 0.47 cm, p < 0.001) and left ventricular end-diastolic dimension (-0.6 ± 0.64 cm vs. -0.3 ± 0.55 cm, p < 0.001) at the 1-month follow-up. A decrease in left ventricular mass was observed in both groups from baseline to 1 month postoperatively, with the SAVR group showing a significantly greater reduction (LV mass: -67.3 ± 59.31 g vs. -38.2 ± 46.49 g, p = 0.003; LVMI: -39.1 ± 33.93 g/m2 vs. -22.5 ± 27.08 g/m2, p = 0.005). However, these differences were not sustained at the 1-year follow-up. SAVR patients experienced a transient decline in right ventricular function at 1 month, which recovered by 1 year postoperatively. At the 1-year follow-up, the TAVR group experienced a higher incidence of Major Adverse Cardiac Events (MACE) (p = 0.01), despite showing significant improvement in the severity of both mitral and tricuspid regurgitation compared to baseline (p < 0.001). Although pulmonary artery pressure improved in both groups after AVR, the SAVR group demonstrated significantly lower pressure at 1 year (p < 0.001).

CONCLUSION: In patients with severe aortic stenosis, SAVR was associated with more significant regression of left ventricular dimensions and mass at 1 month compared to TAVR, alongside a transient impairment of right ventricular function. By 1 year postoperatively, however, no significant differences in ventricular remodeling were observed between the two groups.