Differences in left ventricular remodelling in patients with aortic stenosis treated with transcatheter aortic valve replacement with corevalve prostheses compared to surgery with porcine or bovine biological prostheses.
Patients with severe aortic stenosis (AS) can be considered for treatment with either transcatheter (TAVR) or surgical aortic valve replacement (SAVR). The purpose of this study was to compare left ventricular (LV) remodeling in patients with AS after treatment with TAVR or SAVR.



This is an echocardiographic substudy of the NOTION trial, a randomized all-comers trial comparing TAVR with SAVR in patients above 70 years of age. Transthoracic echocardiograms were performed at baseline, 3 and 12 months after TAVR and SAVR. About 232 patients were included in the study, 120 were randomized to TAVR and 112 to SAVR. From baseline to 12 months post-procedure, aortic valve area (AVA) increased in both groups, but with a larger increase in the TAVR group (0.65 ± 0.04 cm2 vs. 1.02 ± 0.05 cm2 for SAVR and TAVR group, P < 0.0001). At 12 months, LV mass regression was more pronounced in the SAVR group as compared with TAVR (17.5% vs. 7.2%, P < 0.001). In the TAVR group at 12 months, end diastolic volume (EDV) increased by 10.2 ± 2.5 ml and, in the SAVR group, EDV decreased by 15.4 ± 2.6 ml with a statistically significant difference between the two groups (P < 0.0001). Paravalvular leakage (PVL) and pacemaker implantations were more common in patients treated with TAVR, which was associated with an increase in EDV (P < 0.01).



Patients undergoing SAVR had a larger LV mass regression at 1 year compared with patients undergoing TAVR, which may be due to increasing amounts of PVL and pacemakers in the TAVR group.
Department of Cardiology, Zealand University Hospital, Roskilde 4000, Denmark.
Anh
A
Ngo
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
Christian
C
Hassager
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
Hans Gustav Hørsted
HGH
Thyregod
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
Lars
L
Søndergaard
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
Peter Skov
PS
Olsen
Emergency Department, Nykøbing Falster Hospital, Nykøbing Falster 4800, Denmark.
Daniel
D
Steinbrüchel
Department of Cardiac Anesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
Peter Bo
PB
Hansen
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
Jesper
J
Kjærgaard
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
Mathilde
M
Winther-Jensen
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark.
Nikolaj
N
Ihlemann
D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak; D000818:Animals; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002417:Cattle; D003718:Denmark; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D013548:Sweden; D013552:Swine; D013908:Thoracotomy / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D020257:Ventricular Remodeling / Q000502:physiology*
aortic stenosis ; aortic valve replacement ; left ventricular remodelling and paravalvular regurgitation; transcatheter aortic valve implantation 