Author + information
- Received October 30, 2017
- Revision received December 18, 2017
- Accepted December 21, 2017
- Published online February 14, 2018.
- Masahiko Asami, MDa,
- Stefan Stortecky, MDa,
- Fabien Praz, MDa,
- Jonas Lanz, MDa,
- Lorenz Räber, MD, PhDa,
- Anna Franzone, MDa,
- Raffaele Piccolo, MDa,
- George C.M. Siontis, MD, PhDa,
- Dik Heg, PhDb,
- Marco Valgimigli, MD, PhDa,
- Peter Wenaweser, MDa,
- Eva Roost, MDc,
- Stephan Windecker, MDa and
- Thomas Pilgrim, MDa,∗ ()
- aDepartment of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
- bInstitute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
- cDepartment of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
- ↵∗Address for correspondence:
Dr. Thomas Pilgrim, Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freiburg Strasse 10, CH-3010 Bern, Switzerland.
Objectives The purpose of this study was to investigate the association between right ventricular dysfunction (RVD) and cardiovascular death after transcatheter aortic valve replacement (TAVR).
Background There is conflicting evidence on the effect of RVD on clinical outcomes after TAVR.
Methods A total of 1,116 TAVR patients (age 82 ± 6 years; 51% female) who were consecutively enrolled into a prospective registry underwent detailed pre-operative assessment of right ventricular (RV) function and were dichotomized into 2 groups for the purposes of the present retrospective analysis. RVD was assessed using fractional area change (<35%), tricuspid annular plane systolic excursion (<1.7 cm), and systolic movement of the RV lateral wall by tissue Doppler imaging (<9.5 cm/s). RVD was found in 325 (29.1%) patients. The primary outcome was cardiovascular death at 1 year.
Results After adjustment for comorbidities, patients with RVD had a higher risk of cardiovascular death at 1 year compared with patients with normal RV function (20.1% vs. 7.1%; adjusted hazard ratio [HRadj]: 2.94; 95% confidence interval [CI]: 2.02 to 4.27; p < 0.001). The difference emerged within the first 30 days after TAVR (9.0% vs. 2.2%; HRadj: 4.62; 95% CI: 2.51 to 8.50; p < 0.001). Normalization of RV function after TAVR was found in 57.4% of patients with RVD at baseline. There was a gradient of increasing risk of cardiovascular death among patients with normal RV function, RVD recovery (HRadj: 2.16; 95% CI: 1.16 to 4.02), new RVD (HRadj: 3.93; 95% CI: 2.09 to 7.39), and maintained RVD (HRadj: 8.74; 95% CI: 5.33 to 14.3), respectively.
Conclusions RVD at baseline was associated with a more than 2-fold increased risk of cardiovascular death at 1 year after TAVR, with a gradient of risk according to RVD recovery. (Swiss TAVI Registry; NCT01368250)
- aortic stenosis
- recovery of right ventricular function
- right ventricular function
- transcatheter aortic valve replacement
Dr. Praz has served as a consultant for Edwards Lifesciences. Prof. Räber has received research grants to his institution from Biotronik, Sanofi, and Regeneron. Prof. Wenaweser has served as a proctor for Medtronic, Edwards, New Valve Technology, and Boston Scientific. Prof. Windecker has received research grants to his institution from Abbott, Amgen, Boston, Biotronik, and St. Jude Medical. Prof. Pilgrim has received research grants to his institution from Edwards Lifesciences, Symetis, and Biotronik; has received speaker fees from Boston Scientific; and has received reimbursement for travel expenses from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 30, 2017.
- Revision received December 18, 2017.
- Accepted December 21, 2017.
- 2018 American College of Cardiology Foundation
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