Prognostic Impact of Pre-existing Right Ventricular Dysfunction on the Outcome of Transcatheter Aortic Valve Implantation

Aims: Right ventricular dysfunction is a well recognized adverse prognostic factor in patients undergoing surgical aortic valve replacement. The prognostic significance of right ventricular dysfunction in the context of transcatheter aortic valve implantation (TAVI) has not been established. We evaluated the relationship between preprocedural right ventricular impairment and the outcome of TAVI.

Methods And Results: Between December 2007 and December 2011, a total of 155 patients with severe aortic stenosis underwent TAVI at the Sussex Cardiac Centre, of whom 83%-91% had prospective analysis of right ventricular function prior to TAVI using two different standard echocardiographic methods. We identified patients with preserved and impaired ventricular function and compared their all-cause mortality during follow-up. Right ventricular dysfunction was defined as tricuspid annular plane systolic excursion (TAPSE) <15 mm or right ventricular peak systolic velocity (RVPSV) <9 cm/s and was identified in 11% of patients. Vital status was established from the Office of National Statistics. Average follow-up was 628 ± 392 days. A total of 107 patients were followed for at least 1 year and 63 patients for at least 2 years. Cumulative total mortality was 17.4%. In-hospital mortality was 2.6%, death within 30 days was 5.8%, 1-year mortality was 14.0%, and 2-year mortality was 15.9%. There was no statistically significant difference in outcome between patients with and without right ventricular dysfunction. This finding was consistent between the two methods used to determine right ventricular function (TAPSE: hazard ratio [HR] 1.57 and P=.42; RVPSV: HR 1.28 and P=.71).

Conclusions: Preprocedural right ventricular dysfunction does not adversely impair immediate or follow-up survival during medium-term follow-up after TAVI.