Author + information
- Masahiko Asami1,
- Stefan Stortecky2,
- Fabien Praz3,
- Jonas Lanz4,
- Joe Lee1,
- Raffaele Piccolo1,
- George Siontis5,
- Dik Heg6,
- Ernest Spitzer7,
- Eva Roost8,
- Stephan Windecker2 and
- Thomas Pilgrim9
- 1Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
- 2University Hospital Bern, Bern, Switzerland
- 3Columbia University Medical Center, New York City, New York, United States
- 4Inselspital Bern, Bern, Switzerland
- 5University Hospital of Bern, Bern, Switzerland
- 6Clinical Trials Unit, Department of Clinical Research, Institute of Social and, Bern, Switzerland
- 7Erasmus MC, Rotterdam, Netherlands
- 8Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
- 9Bern University Hospital, Berne, Switzerland
There is limited evidence on the impact of right ventricular dysfunction (RVD) on clinical outcomes after transcatheter aortic valve replacement (TAVR). The objective of the present analysis was to investigate the association between RVD and all-cause mortality after TAVR.
A total of 1116 TAVR patients underwent detailed preoperative assessment of RV function, and were dichotomized into two groups (RVD vs. normal RV function). RVD was assessed by use of fractional area change (<35%), tricuspid annular plane systolic excursion (<1.7cm), and systolic movement of the RV lateral wall by tissue Doppler (<9.5cm/s). The primary outcome was all-cause mortality at 1-year.
RVD was found in 325 (29.1%) patients. Patients with RVD were younger compared to patients with normal RV function (81.3±7.1 years vs. 82.5±5.5 years, p=0.002), more commonly male (56.6% vs. 45.8%, p=0.001), more commonly in NYHA functional class III/IV (76.2% vs. 64.1%, p<0.001), and had a higher STS score (7.2±4.7% vs. 5.6±3.9%, p<0.001), lower left ventricular ejection fraction (45.1±16.5% vs. 56.6±12.5%, p<0.001), and a higher brain natriuretic peptide prior to intervention (1165.0±1342.2 pg/ml vs. 522.4±704.5 pg/ml, p<0.001). There were no significant differences with regard to access route or valve type used between the two groups. After adjustment for comorbidities, patients with RVD had a higher risk of death at 1 year as compared to patients with normal RV function (26.2% vs 11.1%, HRadj 2.48, 95% CI 1.82-3.38, p<0.001). The difference emerged within the first 30 days after TAVR (9.9% vs. 2.7%, HRadj 4.09, 95% CI 2.33-7.18, p<0.001) and was driven by a difference in cardiovascular death (9.0% vs. 2.2%, HRadj 4.62, 95% CI 2.51-8.50, p<0.001). In a multivariable analysis, RVD was the strongest independent predictor of 1-year mortality (HRadj 2.20, 95% CI 1.54-3.31), followed by diabetes (HRadj 1.89, 95% CI 1.34-2.67), and history of cerebrovascular events (HRadj 1.73, 95% CI 1.13-2.65).
RVD at baseline was associated with a more than two-fold increased risk of all-cause mortality at 1 year after TAVR.
STRUCTURAL: Valvular Disease: Aortic