Surgical as Opposed to Transcatheter Aortic Valve Replacement Improves Basal Interventricular Septal Hypertrophy

Abstract

Objectives. Basal interventricular septal (IVS) hypertrophy (BSH) with reduced basal IVS contraction and IVS to aorta angle is frequently associated with aortic stenosis (AS). The shape of BSH suggests compression from longitudinally elongated ascending aorta, causing basal IVS thickening and contractile dysfunction, which further suggests the possibility of aortic wall shortening to improve the BSH. Surgical aortic valve replacement (SAVR), as opposed to transcatheter AVR (TAVR), includes aortic wall shortening by incision and stitching on the wall and may potentially improve BSH. We hypothesized that BSH configurations and its contraction improves after SAVR, as opposed to TAVR, in patients with AS and associated BSH. Methods. In 32 patients with SAVR and 36 with TAVR for AS, regional wall thickness and systolic contraction (longitudinal strain) of 18 left ventricular (LV) segments as well as IVS to aorta angle were measured by echocardiography. Results. After SAVR, basal IVS to averaged LV wall thickness ratio, basal IVS strain, and IVS to aorta angle significantly improved (1.11±0.24 to 1.06±0.17, −6.2±5.7 to −9.1±5.2 %, 115±22 to 123±14 degree, p<0.001, respectively). Contractile improvement in basal IVS was correlated with pre-SAVR BSH (basal IVS to averaged LV wall thickness ratio or IVS to aorta angle: r=0.47 and 0.49, p<0.01, respectively). In contrast, these BSH indices did not improve after TAVR. Conclusions. In patients with AS, SAVR as opposed to TAVR improves associated BSH and its functional impairment.

Adverse remodeling in atrial fibrillation following isolated aortic valve replacement surgery

“…This reverse remodeling has already been reported, as Yoshitani et al showed a significant decrease in IVS thickness following aortic valve replacement surgery. 43 The finding regarding the AF group is in line with the previously described pathophysiology, as left atrial pressure is closely related to left ventricle filling pressure, and the latter with IVS thickness. 44 A study by Shah et al found a higher AF recurrence rate following rhythm control strategy in patients presenting with left ventricle hypertrophy.…”

Discrepancy of Aortic Valve Area Measurements by Doppler vs. Biplane Stroke Volume Measurements and Utility of Combining the Different Areas in Aortic Valve Stenosis ― The Asian Valve Registry ―

“…The importance of USH has been reported many times. 5,19,20 The present study also demonstrated the important role of USH in causing increased LVOT VTI, contributing to discrepant AVAIs, and recon-…”

Surgical Therapy for Patients with Severe Aortic Stenosis in the Era of Transcatheter Aortic Valve Replacement

“…Sigmoid septum, which is one of the causes of left ventricular outflow tract (LVOT) obstruction [49], is a non-uniform pattern of hypertrophy in which basal intervetricular septum (IVS) shows a graeter degree of thickening than other regions, and is also characterized by a diminished angle between the basal IVS and the aorta [50][51][52]. Sigmoid septum is incidentally found in patients with older age and hypertension by echocardiography, and basically considered to be of little clinical importance, with a relatively benign prognosis [51][52][53][54]. Because AS develops mainly in the aged population, sigmoid septum is also common in patients with AS.…”

“…Though the mechanism of the formation of sigmoid septum has not been established yet, Yoshitani et al reported that augmented compression by longitudinally elongated ascending aorta to the interventricular septum may cause sigmoid septum, and that the shortening of the elongated ascending aorta could improve sigmoid septum. In this paper, they focused on the shortening of the ascending aorta by aortatomy and suturing in SAVR, which was not performed in TAVR, and found that SAVR as opposed to TAVR improves the interventricular septumaorta angle, basal interventricular septum thickness and its functional impairment [51].…”

“…The degree of septal thickening of the sigmoid septum is often milder than that of hypertrophic cardiomyopathy [51,54,55]. The contribution of septal thickening to LVOT obstruction might be modest in the case of sigmoid septum, differing from HCM [49,52].…”