Long-Term Outcomes in Patients with Perioperative Right Ventricular Dysfunction Undergoing Transcatheter Aortic Valve Replacement

Abstract

Background Right ventricular dysfunction (RVD) has been associated with worst long-term outcome in patients undergoing surgical aortic valve replacement (SAVR). However, there are conflicting data about the long-term consequences of RVD in patients undergoing TAVR. Purpose To evaluate the long-term outcomes of perioperative RVD in patients with severe aortic undergoing TAVR. Methods This is a retrospective cohort study of patients that underwent TAVR in a tertiary cardiovascular center. Right ventricular function was evaluated in the perioperative period (within seven days post-TAVR period) allowing for improvement on left ventricular and right ventricular function after releasing the LVOT obstruction. RV function was dichotomized into two groups for this retrospective analysis. Evaluated outcomes included 30-day mortality, 1-year mortality, hospital stay (LOS), acute kidney injury (AKI), and 30-day readmission rate. Results A total of 409 patients were included in the analysis. Out of 409 patients, 180 (44%) were female with a mean age of 84.6 ± 6.7 years; their mean society of thoracic surgeon score (STS) was 6.4 ±3.8. Transfemoral approach was performed in 313 (77%) patients. A total of 24/409 patients had right ventricular failure within seven days post-TAVR. Please, see table 1 for baseline characteristics. In patients with RVD, one-month mortality occurred in 3/24 (12.5%) patients vs. 19/385 (4.94) in patients with normal right ventricular function p-value 0.1307. One-year mortality was higher in patients with RVD 9/24 (37%) vs. 60 (15%) for patients with normal RV function p-value 0.0103. Post TAVR acute kidney injury was present in 8/24 (33%) patients with RVD vs. 108/385 (28%) for patients with normal RV function, p-value 0.6417. There were no differences in LOS between both groups 8.8 ± 5.6 days vs. 6.87± 4.3 days p-value 0.1092. There were no differences in 30-day readmission rate in patients with RVD 2/24 (8.3%) vs. patients with normal RV function 44/385 (11.4%), p-value 1.000. A multivariable logistic regression that included age, sex, surgical approach, HFrEF, Pro-BNP, albumin, BAV, AKI, and RVD demonstrated that post-procedure AKI (p Conclusion RVD is frequently associated with HFrEF in patients undergoing TAVR. However, it is an independent predictor of one-year mortality in this patient population.