title: Aortic stenosis: right and left ventricular function in the early postprocedural phase. Comparison between transcatheter and surgical aortic valve implantation.
abstract: BACKGROUND
  While impact of surgical aortic valve replacement (SAVR) on the function of the right and left ventricle (RV, LV) has been studied extensively, the objective of this study was to compare the two different transcatheter approaches, transfemoral vs. transapical aortic valve implantation (tf-AVI, ta-AVI) and SAVR with respect to postoperative recovery of RV and LV function in patients with severe aortic stenosis.
  
  
  RESULTS
  Conventional echocardiographic studies were performed before and after the procedure (< 8 days) in 74 consecutive patients undergoing tf-AVI, 88 with ta-AVI and 63 surgically treated patients. Post procedure, a marked deterioration in the tricuspid annular plane systolic excursion (TAPSE) was seen after SAVR (23.7 +/- 4 mm vs. 15.6 +/- 2.9 mm, P > 0.001) and ta-AVI (21.1 +/- 4.7 mm vs. 19.1 +/- 4.7 mm, P = 0.02), while TAPSE remained unchanged in the tf-AVI group (21.7 +/- 5 mm vs. 22.1 +/- 4.9 mm, P = 0.38). Additionally, a significant drop of the visually estimated right ventricular ejection fraction in the SAVR and ta-AVI group compared to tf-AVI could be seen (P < 0.001, P = 0.003, respectively) Among patients with a pre-existing reduced LV-function, despite similar baseline LVEF (38.5 +/- 7.1% vs. 37.4 +/- 5.6, P = 0.8), tf-AVI patients had better recovery of LVEF compared with ta-AVI (ALVEF 7.2 +/- 8% vs. 1.6 +/- 9.3%, P = 0.038).
  
  
  CONCLUSIONS
  Our study underlines the less invasive nature of tf-AVI, causing less intraoperative trauma and pericardial adhesions to the heart. Given that acute RV failure after cardiac surgery remains a major cause of morbidity and mortality, the results of the present study suggest that in high-risk patients, TAVI and in particular tf-AVI could be favoured over SAVR in regard to a RV dysfunction.
authors.affiliation: Dept. of Cardiology, Heart Centre, University Hospital Dresden, Dresden, Germany. Silvio.Quick@mailbox.tu-dresden.de
authors.forename: Silvio
authors.initials: S
authors.lastname: Quick
authors.affiliation: Dept. of Cardiology, Heart Centre, University Hospital Dresden, Dresden, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Speiser
authors.affiliation: Dept. of Cardiology, Heart Centre, University Hospital Dresden, Dresden, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Pfluecke
authors.affiliation: Dept. of Cardiology, Heart Centre, University Hospital Dresden, Dresden, Germany.
authors.forename: Akram
authors.initials: A
authors.lastname: Youssef
authors.affiliation: Dept. of Cardiology, Heart Centre, University Hospital Dresden, Dresden, Germany.
authors.forename: Krunoslav
authors.initials: K
authors.lastname: Sveric
authors.affiliation: Dept. of Cardiology, Heart Centre, University Hospital Dresden, Dresden, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Strasser
authors.affiliation: Dept. of Cardiology, Heart Centre, University Hospital Dresden, Dresden, Germany.
authors.forename: Karim
authors.initials: K
authors.lastname: Ibrahim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*