title: Right ventricular function following surgical aortic valve replacement and transcatheter aortic valve implantation: A cardiovascular MR study.
abstract: OBJECTIVE
  The response of the RV following treatment of aortic stenosis is poorly defined, reflecting the challenge of accurate RV assessment. Cardiovascular magnetic resonance (CMR) is the established reference for imaging of RV volumes, mass and function. We sought to define the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon RV function in patients treated for severe aortic stenosis using CMR.
  
  
  METHODS
  A 1.5T CMR scan was performed preoperatively and 6months postoperatively in 112 (56 TAVI, 56 SAVR; 76±8years) high-risk severe symptomatic aortic stenosis patients across two UK cardiothoracic centres.
  
  
  RESULTS
  TAVI patients were older (80.4±6.7 vs. 72.8±7.2years, p<0.05) with a higher STS score (2.13±0.73 vs. 5.54±3.41%, p<0.001). At 6months, SAVR was associated with a significant increase in RV end systolic volume (33±10 vs. 37±10ml/m2, p=0.008), and decrease in RV ejection fraction (58±8 vs. 53±8%, p=0.005) and tricuspid annular plane systolic excursion (22±5 vs. 14±3mm, p<0.001). Only 4 (7%) SAVR patients had new RV late gadolinium hyper-enhancement with no new cases seen in the TAVI patients at 6months. Longer surgical cross-clamp time was the only predictor of increased RV end systolic volume at 6months. Post-TAVI, there was no observed change in RV volumes or function. Over a maximum 6.3year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had died (p=0.001). On multivariable Cox analysis, the RV mass at 6m post-TAVI was independently associated with all-cause mortality (HR 1.359, 95% CI 1.108-1.666, p=0.003).
  
  
  CONCLUSIONS
  SAVR results in a deterioration in RV systolic volumes and function associated with longer cross-clamp times and is not fully explained by suboptimal RV protection during cardiopulmonary bypass. TAVI had no adverse impact upon RV volumes or function.
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: t.a.musa@leeds.ac.uk.
authors: Tarique Al
authors: TA
authors: Musa
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: a.uddin@leeds.ac.uk.
authors: Akhlaque
authors: A
authors: Uddin
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: timothy.fairbairn@lhch.nhs.uk.
authors: Timothy A
authors: TA
authors: Fairbairn
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: l.dobson@leeds.ac.uk.
authors: Laura E
authors: LE
authors: Dobson
authors: Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK. Electronic address: chris.steadman@poole.nhs.uk.
authors: Christopher D
authors: CD
authors: Steadman
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: a.kidambi@leeds.ac.uk.
authors: Ananth
authors: A
authors: Kidambi
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: d.ripley@leeds.ac.uk.
authors: David P
authors: DP
authors: Ripley
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: p.swoboda@leeds.ac.uk.
authors: Peter P
authors: PP
authors: Swoboda
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: a.k.mcdiarmid@leeds.ac.uk.
authors: Adam K
authors: AK
authors: McDiarmid
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: b.erhayiem@leeds.ac.uk.
authors: Bara
authors: B
authors: Erhayiem
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: p.garg@leeds.ac.uk.
authors: Pankaj
authors: P
authors: Garg
authors: Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK. Electronic address: daniel.blackman1@nhs.net.
authors: Daniel J
authors: DJ
authors: Blackman
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: s.plein@leeds.ac.uk.
authors: Sven
authors: S
authors: Plein
authors: Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK. Electronic address: gerry.mccann@uhl-tr.nhs.uk.
authors: Gerald P
authors: GP
authors: McCann
authors: Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: j.greenwood@leeds.ac.uk.
authors: John P
authors: JP
authors: Greenwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000639:trends; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000401:mortality / Q000639:trends*; D008297:Male; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality / Q000639:trends*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Aortic stenosis; Aortic valve replacement; Cross-clamp time; Right ventricular function; Transcatheter aortic valve implantation