Prognostic Assessment of Right Ventricular Systolic Dysfunction on Post–Transcatheter Aortic Valve Replacement Short‐Term Outcomes: Systematic Review and Meta‐Analysis

Abstract

Background Right ventricular systolic dysfunction ( RVSD ) is a known risk factor for adverse outcome in surgical aortic valve replacement. Transcatheter aortic valve replacement ( TAVR ), on the other hand, has been shown to be either beneficial or have no effect on right ventricular systolic function. However, the prognostic significance of RVSD on TAVR has not been clearly determined. We conducted a systematic review and meta‐analysis to define the impact of RVSD on outcomes in terms of 1‐year mortality in patients with severe aortic stenosis undergoing TAVR . Methods and Results An extensive literature review was performed, with an aim to identify clinical studies that focused on the prognosis and short‐term mortality of patients with severe symptomatic aortic stenosis who underwent TAVR . A total of 3166 patients from 8 selected studies were included. RVSD , as assessed with tricuspid annular plane systolic excursion, fractional area change or ejection fraction, was found to be a predictor of adverse procedural outcome after TAVR (hazard ratio, 1.31; 95% CI, 1.1–1.55; P =0.002). Overall, we found that RVSD did affect post‐ TAVR prognosis in 1‐year mortality rate. Conclusions Patients with severe, symptomatic aortic stenosis and concomitant severe RVSD have a poor 1‐year post‐ TAVR prognosis when compared with patients without RVSD . Right ventricular dilation and severe tricuspid regurgitation were associated with increased 1‐year morality post‐ TAVR and should be considered as independent risk factors. Further evaluations of long‐term morbidity, mortality, as well as sustained improvement in functional class and symptoms need to be conducted to determine the long‐term effects.

Prognostic implication of right ventricular dysfunction and tricuspid regurgitation following transcatheter aortic valve replacement

“…In our cohort 4% of patients with assessment of RV function had ≥moderate RV dysfunction. The impact of RV function on long‐term mortality after TAVR is less studied compared with TR grade, but our results again support previous reports, 22‐24 and a recent meta‐analysis 25 in which, qualitative RV dysfunction was related in univariate analysis to mortality (HR 1.73, 95% CI 1.21–2.47, p = .003). However, when adjusted to major clinical or echocardiographic parameters this significance was lost.…”

Right ventricle to pulmonary artery coupling after transcatheter aortic valve implantation—Determinant factors and prognostic impact

“…This calls for a detailed examination of patient-related factors that have an impact on long-term survival ( 8 ). Among these, right ventricular (RV) dysfunction and pulmonary hypertension have been shown to have a negative prognostic impact after TAVI ( 9 – 11 ). Only a few studies have analyzed the synergic impact of these factors on mortality, by evaluating the RV to pulmonary artery (RV-PA) coupling, which integrates the RV systolic performance at a given degree of afterload through a non-invasive parameter, but using different parameters or in chronic heart failure patients ( 12 , 13 ).…”

Twelve-month outcomes of transapical transcatheter aortic valve implantation in patients with severe aortic valve stenosis

“…The currently available registries made it possible to create a predictor model of unfavorable outcomes after TAVI. Factors with a significant influence are chronic oxygen therapy, advanced renal failure, atrial fibrillation, poor functional capacity, and decreased baseline cognitive function [24][25][26]. In our study we found that the history of CVE is strongly related to increased mortality.…”