Author + information
- Paul Cremer,
- L. Leonardo Rodriguez,
- Yiran Zhang,
- Maria Alu,
- Brian Lindman,
- Alan Zajarias,
- Rebecca Hahn,
- Stamatios Lerakis,
- S. Chris Malaisrie,
- Pamela Douglas,
- Philippe Pibarot,
- Lars Svensson,
- Martin Leon and
- Wael Jaber
Background: Right ventricular (RV) function can worsen after surgical aortic valve replacement (SAVR), but the incidence of RV dysfunction after SAVR vs. transcatheter aortic valve replacement (TAVR) is not well described. We hypothesized that RV dysfunction would be more common after SAVR and would be associated with higher mortality.
Methods: Patients from PARTNER2A with a core lab echo at baseline and 30 days were included. Our primary outcomes were cardiac death from 30 days to 2 years and worsening of RV function, defined as worsening by at least one grade on a multiparametric assessment at 30-days compared to baseline. Univariable associations with RV dysfunction were assessed with t-tests and multivariable analysis was performed with stepwise logistic regression. Survival analysis was assessed via the Kaplan-Meier method and multivariable Cox proportional hazards models. A two-sided p value <0.05 was considered statistically significant.
Results: Among 1,388 patients, worsening RV function was more common after SAVR (24.5%) vs TAVR (8.3%)(p<0.001). In a multivariable model, worsening RV function remained less common with TAVR (OR 0.29, 95% CI 0.19-0.44). Moreover, decline in RV function was associated with cardiac death in univariable (HR 2.0, 95% CI 1.2-3.2)(Figure) and multivariable (HR 1.8, 95% CI 1.1-3.1) analyses.
Conclusions: In intermediate-risk patients, SAVR is associated with worsening RV function. In all patients, worsening RV function was associated with lower survival.
Saturday, March 18, 2017, 9:17 a.m.-9:27 a.m.
Session Title: Highlighted Original Research: Interventional Cardiology and the Year in Review
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 903-14
- 2017 American College of Cardiology Foundation