Prognostic value of right ventricular dysfunction in aortic regurgitation after transcatheter aortic valve replacement

Yu Mao; Yang Liu; Mengen Zhai; Ping Jin; Haibo Zhang; Lai Wei; Xiaoke Shang; Yingqiang Guo; Xiangbin Pan; Jian Yang

doi:10.3389/fcvm.2024.1424116

Prognostic value of right ventricular dysfunction in aortic regurgitation after transcatheter aortic valve replacement

Front Cardiovasc Med. 2024 Aug 30:11:1424116. doi: 10.3389/fcvm.2024.1424116. eCollection 2024.

Authors

Yu Mao¹, Yang Liu¹, Mengen Zhai¹, Ping Jin¹, Haibo Zhang², Lai Wei³, Xiaoke Shang⁴, Yingqiang Guo⁵, Xiangbin Pan⁶, Jian Yang¹

Affiliations

¹ Department of Cardiovascular Surgery, Xijing Hospital, Xi'an, Shaanxi, China.
² Department of Cardiovascular Surgery, Anzhen Hospital, Capital Medical University, Beijing, China.
³ Department of Cardiovascular Surgery, Shanghai Cardiovascular Institution and Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
⁵ Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁶ Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

Abstract

Background: Aortic regurgitation (AR) may lead to right ventricular dysfunction (RVD), but the prognostic value of RVD in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear. Our goal was to evaluate the clinical implications, predictors and prognostic significance of RVD in patients with pure AR after TAVR.

Methods: In this multicentre prospective study, patients undergoing TAVR were included between January 2019 and April 2021. The patients were divided into four groups according to the results of transthoracic echocardiography pre- and post-TAVR. The primary end point was 2-year all-cause mortality.

Results: A total of 648 patients were divided into four groups: 325 patients (54.3%) in the no RVD group; 106 patients (17.7%) in the new-onset RVD group; 73 patients (12.2%) in the normalized RVD group; and 94 patients (15.7%) in the residual RVD group. At the 2-year follow-up, there were significant differences in all-cause mortality among the four groups (5.2%, 12.3%, 11.0% and 17.0%, respectively; p < 0.05). New-onset RVD was correlated with an increased risk of all-cause death and a composite end point and normalized RVD improved clinical outcomes of baseline RVD. Predictors of new-onset RVD included a higher Society of Thoracic Surgeons score, larger left ventricular end-diastolic volume, lower left ventricular ejection fraction, higher systolic pulmonary artery pressure and smaller RV base diameter.

Conclusions: Changes in periprocedural RVD status significantly affect the risk stratification outcomes after TAVR. Therefore, they may be used as part of decision-making and risk assessment strategies.

Clinical trial registration: ClinicalTrials.gov Protocol Registration System (NCT02917980).

Keywords: aortic regurgitation; aortic valve; prognosis; right ventricular dysfunction; transcatheter aortic valve replacement.

Associated data

ClinicalTrials.gov/NCT02917980

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Key R&D Program of China (2020YFC2008100); the Development and Transformation of New Technology and Construction of Precision Diagnosis and Treatment System for Transcatheter Interventional Diagnosis and Treatment of Structural Heart Diseases (2022YFC2503400); National Natural Science Foundation (82370375); Research on Key Techniques of Minimally Invasive Treatment for Valvular Heart Diseases (2023-YBSF-105); Xijing Hospital Booster Foundation (XJZT24LY42).