Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Unsworth B, Casula RP, Yadav H, et al. Contrasting effect of different cardiothoracic operations on echocardiographic right ventricular long axis velocities, and implications for interpretation of post-operative values. Int J Cardiol 2013;165:151–60. 10.1016/j.ijcard.2011.08.031 - DOI - PMC - PubMed
    1. Gilmanov D, Solinas M, Farneti PA, et al. Minimally invasive aortic valve replacement: 12-year single center experience. Ann Cardiothorac Surg 2015;4:160–9. 10.3978/j.issn.2225-319X.2014.12.05 - DOI - PMC - PubMed
    1. Dalén M, Biancari F, Rubino AS, et al. Aortic valve replacement through full sternotomy with a stented bioprosthesis versus minimally invasive sternotomy with a sutureless bioprosthesis. Eur J Cardiothorac Surg 2016;49:220–7. 10.1093/ejcts/ezv014 - DOI - PubMed
    1. Brown ML, McKellar SH, Sundt TM, et al. Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 2009;137:670–9. 10.1016/j.jtcvs.2008.08.010 - DOI - PubMed
    1. de Groote P, Millaire A, Foucher-Hossein C, et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol 1998;32:948–54. 10.1016/S0735-1097(98)00337-4 - DOI - PubMed

Publication types

LinkOut - more resources