A critical review of hemodynamic changes and left ventricular remodeling after surgical aortic valve replacement and percutaneous aortic valve replacement

Kim, Shin-Jae; Samad, Zainab; Bloomfield, Gerald S.; Douglas, Pamela S.

doi:10.1016/j.ahj.2014.04.015

Cited by 33 publications

(15 citation statements)

References 78 publications

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“…17,25 This complicates the finding that LV mass regression is greater after SAVR given the significantly lower rate of PPM in TAVR and higher survival after CoreValve implantation compared to SAVR. 9 The majority of LV mass regression after AVR (10% to 30%) is complete by 1 year, but this process of reverse remodeling continues for several years after AVR, 26,27 despite the presence of a constant, albeit smaller, pressure gradient with the prosthesis. Available data, although limited, suggest that residual LV hypertrophy has a negative impact on long-term survival after AVR in patients with severe aortic stenosis, 25,28 but other findings indicate that only a high preoperative LV mass, and not the extent of LV mass regression, determine clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

et al. 2017

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Section: Discussionmentioning

confidence: 99%

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

et al. 2017

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“…Although long-term follow-up data after TAVR is not available, LV remodelling seems to be comparable with that after SAVR, with the notable exception of slower regression of LV mass and decreased frequency of patient–prosthesis mismatch 25. Studies on diastolic dysfunction after TAVR have been limited in number.…”

Section: Diastolic Dysfunction Before and After Avrmentioning

confidence: 99%

The role and clinical implications of diastolic dysfunction in aortic stenosis

Kampaktsis

Kokkinidis

Wong

et al. 2017

Heart

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Diastolic dysfunction in aortic stenosis results primarily from left ventricular hypertrophy and myocardial fibrosis due to chronically elevated left ventricular systolic pressure. Currently, diastolic dysfunction does not have an explicit clinical role in management of patients with aortic stenosis. Studies have shown that improvement in diastolic dysfunction follows left ventricular remodelling after aortic valve replacement and that it occurs gradually or incompletely. Retrospective studies suggest that advanced grades of diastolic dysfunction at baseline are associated with increased mortality and adverse events even after aortic valve replacement. Recent studies have also associated myocardial fibrosis, a hallmark of diastolic dysfunction, with worse outcomes. In addition, these results were independent of the degree of aortic stenosis or valve replacement. Indirect evidence of the role of diastolic dysfunction in aortic stenosis also comes from paradoxical low-flow, low-gradient aortic stenosis, where disproportionate left ventricular hypertrophy leads to underfilling of the left ventricle, low-flow state and is associated with worse prognosis. Lastly, a limited number of studies suggest that worse diastolic dysfunction at baseline is detrimental in patients who develop aortic regurgitation after transcatheteraortic valve replacement, due to superimposition of volume overload on a stiff left ventricle. Current major limitations in our understanding of the prognostic role of diastolic dysfunction are the lack of universally accepted classification schemes, its dependence on dynamic loading conditions and the lack of larger prospective studies.

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“…Transcatheter aortic valve replacement (TAVR) is now a common therapy for patients with severe aortic stenosis (AS) at high risk for open‐heart surgery . Although TAVR has better hemodynamics than surgical prostheses, occurrence of prosthesis‐patient mismatch (PPM) remains high, with reported incidence often >40% . PPM after surgical aortic valve replacement (SAVR) negatively affects left ventricular (LV) remodeling and has an impact on morbidity and mortality .…”

Section: Introductionmentioning

confidence: 99%

Impact of Prosthesis‐Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement

Poulin

Yingchoncharoen

Wilson

et al. 2016

JAHA

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BackgroundThe aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis‐patient mismatch (PPM).Methods and ResultsIn a retrospective study, speckle‐tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid‐term follow‐up post‐TAVR. Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm2/m2, respectively. A total of 102 patients (median age, 83 years [77–88]) with severe AS were included. At 6±3 months post‐TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m2; P=0.001) at follow‐up whereas those with PPM did not. There was a significant improvement in LV GLS (−12.8±4.0 to −14.3±4.3%; P=0.01), GLSR (−0.61±0.20 to −0.73±0.25 second−1; P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second−1; P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre‐TAVR ejection fraction and post‐TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow‐up of 46.1 months (interquartile range, 35.4–60.8), there was no difference in survival between patients with and without PPM.Conclusions TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.

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A critical review of hemodynamic changes and left ventricular remodeling after surgical aortic valve replacement and percutaneous aortic valve replacement

Cited by 33 publications

References 78 publications

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

The role and clinical implications of diastolic dysfunction in aortic stenosis

Impact of Prosthesis‐Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement

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