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. 2018 Jul 23;5(2):e000842.
doi: 10.1136/openhrt-2018-000842. eCollection 2018.

Right ventricular mechanics and contractility after aortic valve replacement surgery: a randomised study comparing minimally invasive versus conventional approach

Nashmil Hashemi  1   2 , Jonas Johnson  3 , Lars-Åke Brodin  3 , Andreia Gomes-Bernardes  2 , Ulrik Sartipy  4   5 , Peter Svenarud  4   5 , Magnus Dalén  4   5 , Magnus Bäck  6 , Mahbubul Alam  1 , Reidar Winter  1
Affiliations

Right ventricular mechanics and contractility after aortic valve replacement surgery: a randomised study comparing minimally invasive versus conventional approach

Nashmil Hashemi et al. Open Heart. .

Abstract

Objective: Minimally invasive aortic valve replacementsurgery (MIAVR) is an alternative surgical technique to conventional aortic valve replacement surgery (AVR) in selected patients. The randomised study Cardiac Function after Minimally Invasive Aortic Valve Implantation (CMILE) showed that right ventricular (RV) longitudinal function was reduced after both MIAVR and AVR, but the reduction was more pronounced following AVR. However, postoperative global RV function was equally impaired in both groups. The purpose of this study was to explore alterations in RV mechanics and contractility following MIAVR as compared with AVR.

Methods: A predefined post hoc analysis of CMILE consisting of 40 patients with severe aortic valve stenosis who were eligible for isolated surgical aortic valve replacement were randomised to MIAVR or AVR. RV function was assessed by echocardiography prior to surgery and 40 days post-surgery.

Results: Comparing preoperative to postoperative values, RV longitudinal strain rate was preserved following MIAVR (-1.5±0.5 vs -1.5±0.4 1/s, p=0.84) but declined following AVR (-1.7±0.3 vs -1.4±0.3 1/s, p<0.01). RV longitudinal strain reduced following AVR (-27.4±2.9% vs -18.8%±4.7%, p<0.001) and MIAVR (-26.5±5.3% vs -20.7%±4.5%, p<0.01). Peak systolic velocity of the lateral tricuspid annulus reduced by 36.6% in the AVR group (9.3±2.1 vs 5.9±1.5 cm/s, p<0.01) and 18.8% in the MIAVR group (10.1±2.9 vs 8.2±1.4 cm/s, p<0.01) when comparing preoperative values with postoperative values.

Conclusions: RV contractility was preserved following MIAVR but was deteriorated following AVR. RV longitudinal function reduced substantially following AVR. A decline in RV longitudinal function was also observed following MIAVR, however, to a much lesser extent.

Keywords: aortic valve disease; cardiac function; echocardiography; minimally invasive; surgery-valve.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Automated analysis of cardiac velocities and time intervals: positioning region of interest (A); the curves in GHLab (B).
Figure 2
Figure 2
Changes in the parameters of right ventricular function in patients undergoing aortic valve replacement surgery (AVR) and minimally invasive aortic valve replacement surgery (MIAVR) comparing preoperative to postoperative values. RIMP, right ventricular index of myocardial performance; RV-FAC, right ventricular fractional area change; RV-LS, right ventricular longitudinal strain; RV-LSR, right ventricular longitudinal strain rate.
Figure 3
Figure 3
Example of right ventricular cardiac state diagram (CSD) displaying postoperative alterations in different phases of one cardiac cycle. AVR, aortic valve replacement surgery; MIAVR, minimally invasive aortic valve replacement surgery.
See this image and copyright information in PMC

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