Prognostic value of right ventricular dysfunction in patients undergoing transcatheter aortic valve replacement

Abstract

Abstract Introduction Right ventricular dysfunction (RVD) in patients with severe aortic stenosis seems to increase the risk of worse long-term outcomes after transcatheter aortic valve replacement (TAVR). The purpose of this study was to investigate the association between RVD at baseline and the prognosis after TAVR (readmission for heart failure and death). Methods A cohort study was conducted. Consecutive patients undergoing TAVR from January 2012 to December 2020 were included and analysed depending on the right ventricular function prior to the procedure. RVD was assessed using tricuspid annular plane systolic excursion (≤17 mm). Clinical and follow-up characteristics were recorded. The median follow-up was 26±22 months. Results Of 292 patients who underwent TAVR, 64 (21.9%) met the criteria for RVD at baseline. Patients with RVD undergoing TAVR were significantly more often male (65% vs 46%) and smokers or former smokers (42% vs 23%). They had significantly a higher EuroScore risk score (9.1±7.2 vs 5.3±4) with greater prevalence of atrial fibrillation (55% vs 32%), previous heart valve surgery (20% vs 4%) or pacemaker implant (25% vs 14%), less left ventricular ejection fraction (48±15% vs 58±11%), lower aortic valve mean gradient (41±13 vs 50±13 mmHg) and higher estimated pulmonary artery pressure (50±18 vs 42±13 mmHg) compared with patients with preserved RV function. Procedural characteristics and complications were similar in both groups. Normalization of right ventricular function after TAVR was found in 50.8% of patients with RVD at baseline. Readmission for heart failure during the follow-up was more common in patients with RVD at baseline (29.7% vs 13.3%, p 0.04), also observing a higher trend in terms of mortality (29.7% vs 19.1%, p 0.08). Conclusions Patients with RVD undergoing TAVR had an increased risk of readmission for heart failure and a higher trend in mortality. Funding Acknowledgement Type of funding sources: None.