title: Early effects of transcatheter aortic valve implantation and aortic valve replacement on myocardial function and aortic valve hemodynamics: insights from cardiovascular magnetic resonance imaging.
abstract: OBJECTIVE
  There remains a paucity of mechanistic data on the effect of transcatheter aortic valve implantation (TAVI) on early left and right ventricular function and quantitative aortic valve regurgitation. We sought to assess and compare the early effects on myocardial function and aortic valve hemodynamics of TAVI and aortic valve replacement (AVR) using serial cardiovascular magnetic resonance (CMR) imaging and echocardiography.
  
  
  METHODS
  A prospective comparison study of 47 patients with severe aortic stenosis undergoing either TAVI (n = 26) or high-risk AVR (n = 21). CMR (for left ventricle/right ventricle function, left ventricular mass, left atrial volume, and aortic regurgitation) was carried out before the procedure and early postprocedure (<14 days).
  
  
  RESULTS
  Groups were similar with respect to Society of Thoracic Surgeons score (TAVI, 7.7 vs AVR, 5.9; P = .11). Preoperative left ventricular (TAVI, 69% ± 13% vs AVR, 73% ± 10%; P = .10) and right ventricular (TAVI, 61% ± 11% vs AVR, 59% ± 8%; P = .5) ejection fractions were similar. Postoperative left ventricular ejection fraction was preserved in both groups. In contrast, decline in right ventricular ejection fraction was more significant in the TAVI group (61%-54% vs 59%-58%; P = .01). Postprocedure aortic regurgitant fraction was significantly greater in the TAVI group (16% vs 4%; P = .001), as was left atrial size (110 vs 84 mL; P = .02). Further analysis revealed a significant relationship between the increased aortic regurgitant fraction and greater left atrial size (P = .006), and a trend toward association between the decline in right ventricle dysfunction and increased postprocedure aortic regurgitation (P = .08).
  
  
  CONCLUSIONS
  There was no significant difference in early left ventricular systolic function between techniques. Whereas right ventricle systolic function was preserved in the AVR group, it was significantly impaired early after TAVI, possibly reflecting a clinically important pathophysiologic consequence of paravalvular aortic regurgitation.
authors.affiliation: Flinders University, Adelaide, Australia; Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Gareth
authors.initials: G
authors.lastname: Crouch
authors.affiliation: Flinders University, Adelaide, Australia; Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Jayme
authors.initials: J
authors.lastname: Bennetts
authors.affiliation: Department of Cardiology, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Ajay
authors.initials: A
authors.lastname: Sinhal
authors.affiliation: Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: Flinders University, Adelaide, Australia.
authors.forename: Darryl P
authors.initials: DP
authors.lastname: Leong
authors.affiliation: Department of Cardiology, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Bradbrook
authors.affiliation: Department of Cardiology, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Penhall
authors.affiliation: Flinders University, Adelaide, Australia; Department of Cardiology, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Carmine G
authors.initials: CG
authors.lastname: De Pasquale
authors.affiliation: Department of Cardiology, Flinders Medical Centre, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Adhiraj
authors.initials: A
authors.lastname: Chakrabarty
authors.affiliation: Flinders University, Adelaide, Australia; Department of Cardiothoracic Surgery, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.affiliation: Flinders University, Adelaide, Australia; Department of Cardiology, Flinders Medical Centre, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia. Electronic address: joseph.selva@health.sa.gov.au.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Selvanayagam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology* / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology* / Q000601:surgery*; D006328:Cardiac Catheterization; D003287:Contrast Media; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D006334:Heart Function Tests; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009942:Organometallic Compounds; D011446:Prospective Studies; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000175:diagnosis / Q000503:physiopathology*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol