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Comparative Study
. 2018 Jan:221:304-310.
doi: 10.1016/j.jss.2017.08.036. Epub 2017 Oct 7.

Myocardial functional changes in transfemoral versus transapical aortic valve replacement

Niraj Asthana  1 , Aditya Mantha  1 , Eric H Yang  2 , William Suh  2 , Olcay Aksoy  2 , Richard J Shemin  1 , Gabriel Vorobiof  2 , Peyman Benharash  3
Affiliations
Free article
Comparative Study

Myocardial functional changes in transfemoral versus transapical aortic valve replacement

Niraj Asthana et al. J Surg Res. 2018 Jan.
Free article

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has greatly expanded the treatment options available for patients with severe aortic stenosis at high surgical risk.

Materials and methods: We compared changes in myocardial function in TAVR with a transfemoral (TF) versus a transapical (TA) approach at a major tertiary hospital from 2012-2016. Traditional echocardiographic measures of cardiac structure and function were tracked, alongside the use of two-dimensional speckle tracking echocardiography to measure myocardial strain and strain rates.

Results: For the entire cohort with complete data at all time points (n = 42), between the pre-TAVR baseline (mean: 20.1 d) and the post-TAVR 1-mo follow-up (mean: 32.7 d), global longitudinal strain significantly increased (from -15.6% to -18.2%, P < 0.001). When comparing the TF (n = 31) and TA (n = 11) groups, TA patients showed persistently impaired apical longitudinal strain at the 1-mo follow-up (-15.9% versus -22.3%, P < 0.05). In terms of clinical outcomes, both groups (n = 131 for TF, n = 53 for TA) were similar in terms of 30-d mortality, readmission rate, and risk of post-TAVR acute kidney injury. However, TA patients experienced significantly longer length of hospitalization (7.58 versus 3.92 d, P = 0.02), intensive care unit hours (105.4 versus 47.1 h, P = 0.02), and were at a greater risk of long-term (>72 h) intensive care unit stay (45% versus 25%, P = 0.01).

Conclusions: Patients undergoing TA-TAVR exhibit impaired apical longitudinal strain, although global myocardial function is similar to TF-TAVR otherwise. Myocardial strain measured by two-dimensional speckle tracking echocardiography appears to be a sensitive method to detect subtle cardiac remodeling after TAVR.

Keywords: Functional improvement; Global longitudinal strain; Myocardial function; Speckle tracking echocardiography; Transapical TAVR; Transcatheter aortic valve replacement; Transfemoral TAVR.

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