title: Right ventricular function after aortic valve replacement: a pilot study comparing surgical and transcatheter procedures using 3D echocardiography.
abstract: OBJECTIVE
  Previous studies have found that standard echocardiographic measures of right ventricular (RV) function were impaired after surgical replacement of the aortic valve (SAVR), but not after transcatheter aortic valve implantation (TAVI). We used 3D echocardiography to gain further insight into the changes of RV performance in patient undergoing SAVR or TAVI.
  
  
  METHODS
  We conducted a prospective non-randomized study with two parallel groups and performed echocardiographic evaluation in 20 patients with aortic stenosis undergoing SAVR (age 77 ± 4 years), and in 20 patients undergoing TAVI via the transfemoral approach (age 83 ± 6 years) 1 week before and between the fifth and seventh day after the procedure.
  
  
  RESULTS
  Tricuspid annular plane systolic excursion was postoperatively markedly reduced in patients undergoing SAVR (13 ± 2 vs 26 ± 4 mm, post- vs preoperative, P < 0.001), but not in patients undergoing TAVI (24 ± 7 vs 24 ± 5 mm, P = 0.90). Fractional shortening of the RV midcavity transverse diameter, however, increased after SAVR (50 ± 8 vs 31 ± 11%, P < 0.001) in contrast to TAVI (33 ± 10 vs 34 ± 9%, P = 0.85). The RV ejection fraction, assessed by 3D echocardiography, remained unchanged in both patient groups (SAVR, 55 ± 6 vs 55 ± 7%, P = 0.52; TAVI, 56 ± 8 vs 54 ± 7%, P = 0.28).
  
  
  CONCLUSIONS
  RV longitudinal contraction decreased after SAVR, whereas RV transverse contraction increased. Both parameters did not change after TAVI. RV ejection fraction and RV stroke volume remained constant irrespective of the technique of aortic valve replacement, thus indicating that global systolic RV function is not compromised after SAVR.
authors.affiliation: Department of Anesthesiology, Heart Center Freiburg University, Bad Krozingen, Germany cornelius.keyl@universitaets-herzzentrum.de.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Keyl
authors.affiliation: Department of Cardiology and Angiology II, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.affiliation: Department of Cardiology and Angiology II, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ruile
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Siepe
authors.affiliation: Department of Anesthesiology, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Pioch
authors.affiliation: Department of Cardiology and Angiology II, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schneider
authors.affiliation: Department of Cardiology and Angiology II, Heart Center Freiburg University, Bad Krozingen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Jander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Aortic stenosis; Aortic valve replacement; Echocardiography; Right ventricular function; Transcatheter aortic valve implantation