Right Ventricular Mechanics and Contractility After Aortic Valve Replacement Surgery: a Randomised Study Comparing Minimally Invasive Versus Conventional Approach

Overview

Journal Open Heart

Publisher BMJ Publishing Group

Specialty Cardiology & Vascular Diseases

Date 2018 Jul 31

PMID 30057770

Citations 5

Authors

Nashmil Hashemi

Jonas Johnson

Lars-Ake Brodin

Andreia Gomes-Bernardes

Ulrik Sartipy

Peter Svenarud

Magnus Dalen

Magnus Back

Mahbubul Alam

Reidar Winter

Affiliations

Soon will be listed here.

Abstract

Objective: Minimally invasive aortic valve replacementsurgery (MIAVR) is an alternative surgical technique to conventional aortic valve replacement surgery (AVR) in selected patients. The randomised study Cardiac Function after Minimally Invasive Aortic Valve Implantation (CMILE) showed that right ventricular (RV) longitudinal function was reduced after both MIAVR and AVR, but the reduction was more pronounced following AVR. However, postoperative global RV function was equally impaired in both groups. The purpose of this study was to explore alterations in RV mechanics and contractility following MIAVR as compared with AVR.

Methods: A predefined post hoc analysis of CMILE consisting of 40 patients with severe aortic valve stenosis who were eligible for isolated surgical aortic valve replacement were randomised to MIAVR or AVR. RV function was assessed by echocardiography prior to surgery and 40 days post-surgery.

Results: Comparing preoperative to postoperative values, RV longitudinal strain rate was preserved following MIAVR (-1.5±0.5 vs -1.5±0.4 1/s, p=0.84) but declined following AVR (-1.7±0.3 vs -1.4±0.3 1/s, p<0.01). RV longitudinal strain reduced following AVR (-27.4±2.9% vs -18.8%±4.7%, p<0.001) and MIAVR (-26.5±5.3% vs -20.7%±4.5%, p<0.01). Peak systolic velocity of the lateral tricuspid annulus reduced by 36.6% in the AVR group (9.3±2.1 vs 5.9±1.5 cm/s, p<0.01) and 18.8% in the MIAVR group (10.1±2.9 vs 8.2±1.4 cm/s, p<0.01) when comparing preoperative values with postoperative values.

Conclusions: RV contractility was preserved following MIAVR but was deteriorated following AVR. RV longitudinal function reduced substantially following AVR. A decline in RV longitudinal function was also observed following MIAVR, however, to a much lesser extent.

Citing Articles

Bleeding in minimally invasive versus conventional aortic valve replacement.

Bratt S, Dimberg A, Kastengren M, Lilford R, Svenarud P, Sartipy U J Cardiothorac Surg. 2024; 19(1):349.

PMID: 38907320 PMC: 11191138. DOI: 10.1186/s13019-024-02667-1.

Right Ventricular Dysfunction before and after Cardiac Surgery: Prognostic Implications.

Merlo A, Cirelli C, Vizzardi E, Fiorendi L, Roncali F, Marino M J Clin Med. 2024; 13(6).

PMID: 38541835 PMC: 10971639. DOI: 10.3390/jcm13061609.

Limited versus full sternotomy for aortic valve replacement.

Kirmani B, Jones S, Muir A, Malaisrie S, Chung D, Williams R Cochrane Database Syst Rev. 2023; 12:CD011793.

PMID: 38054555 PMC: 10698838. DOI: 10.1002/14651858.CD011793.pub3.

Upper Hemi-Sternotomy Provides Benefit for Patients with Isolated or Combined Mitral Valve Surgery.

Oezpeker C, Barbieri F, Hoefer D, Bonaros N, Grimm M, Mueller L Medicina (Kaunas). 2022; 58(2).

PMID: 35208468 PMC: 8874458. DOI: 10.3390/medicina58020142.

Characterization of biventricular alterations in myocardial (reverse) remodelling in aortic banding-induced chronic pressure overload.

Miranda-Silva D, Goncalves-Rodrigues P, Almeida-Coelho J, Hamdani N, Lima T, Conceicao G Sci Rep. 2019; 9(1):2956.

PMID: 30814653 PMC: 6393473. DOI: 10.1038/s41598-019-39581-9.

References

Unsworth B, Casula R, Yadav H, Baruah R, Hughes A, Mayet J . Contrasting effect of different cardiothoracic operations on echocardiographic right ventricular long axis velocities, and implications for interpretation of post-operative values. Int J Cardiol. 2011; 165(1):151-60. PMC: 3635119. DOI: 10.1016/j.ijcard.2011.08.031. View

Haddad F, Denault A, Couture P, Cartier R, Pellerin M, Levesque S . Right ventricular myocardial performance index predicts perioperative mortality or circulatory failure in high-risk valvular surgery. J Am Soc Echocardiogr. 2007; 20(9):1065-72. DOI: 10.1016/j.echo.2007.02.017. View

Okada D, Rahmouni H, Herrmann H, Bavaria J, Forfia P, Han Y . Assessment of right ventricular function by transthoracic echocardiography following aortic valve replacement. Echocardiography. 2013; 31(5):552-7. DOI: 10.1111/echo.12421. View

Lindqvist P, Holmgren A, Zhao Y, Henein M . Effect of pericardial repair after aortic valve replacement on septal and right ventricular function. Int J Cardiol. 2010; 155(3):388-93. DOI: 10.1016/j.ijcard.2010.10.049. View

Keyl C, Schneider J, Beyersdorf F, Ruile P, Siepe M, Pioch K . Right ventricular function after aortic valve replacement: a pilot study comparing surgical and transcatheter procedures using 3D echocardiography. Eur J Cardiothorac Surg. 2015; 49(3):966-71. DOI: 10.1093/ejcts/ezv227. View

Larsson M, Bjallmark A, Johnson J, Winter R, Brodin L, Lundback S . State diagrams of the heart--a new approach to describing cardiac mechanics. Cardiovasc Ultrasound. 2009; 7:22. PMC: 2693107. DOI: 10.1186/1476-7120-7-22. View

Nishimura R, Otto C, Bonow R, Carabello B, Erwin 3rd J, OGara P . 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014; 148(1):e1-e132. DOI: 10.1016/j.jtcvs.2014.05.014. View

Kjaergaard J, Snyder E, Hassager C, Oh J, Johnson B . Impact of preload and afterload on global and regional right ventricular function and pressure: a quantitative echocardiography study. J Am Soc Echocardiogr. 2006; 19(5):515-21. DOI: 10.1016/j.echo.2005.12.021. View

Di Salvo T, Mathier M, Semigran M, Dec G . Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol. 1995; 25(5):1143-53. DOI: 10.1016/0735-1097(94)00511-n. View

10.

Boldt J, Zickmann B, Ballesteros M, Dapper F, Hempelmann G . RETRACTED: Right ventricular function in patients with aortic stenosis undergoing aortic valve replacement. J Cardiothorac Vasc Anesth. 1992; 6(3):287-291. DOI: 10.1016/1053-0770(92)90141-S. View

11.

de Groote P, Millaire A, Nugue O, Marchandise X, DUCLOUX G, Lablanche J . Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol. 1998; 32(4):948-54. DOI: 10.1016/s0735-1097(98)00337-4. View

12.

Dhooge J, HEIMDAL A, Jamal F, Kukulski T, Bijnens B, Rademakers F . Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr. 2002; 1(3):154-70. DOI: 10.1053/euje.2000.0031. View

13.

Dalen M, Biancari F, Rubino A, Santarpino G, Glaser N, De Praetere H . Aortic valve replacement through full sternotomy with a stented bioprosthesis versus minimally invasive sternotomy with a sutureless bioprosthesis. Eur J Cardiothorac Surg. 2015; 49(1):220-7. DOI: 10.1093/ejcts/ezv014. View

14.

Portnoy S, Rudski L . Echocardiographic evaluation of the right ventricle: a 2014 perspective. Curr Cardiol Rep. 2015; 17(4):21. DOI: 10.1007/s11886-015-0578-8. View

15.

Quinones M, Otto C, Stoddard M, Waggoner A, Zoghbi W . Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002; 15(2):167-84. DOI: 10.1067/mje.2002.120202. View

16.

Dalen M, Oliveira Da Silva C, Sartipy U, Winter R, Franco-Cereceda A, Barimani J . Comparison of right ventricular function after ministernotomy and full sternotomy aortic valve replacement: a randomized study. Interact Cardiovasc Thorac Surg. 2018; 26(5):790-797. DOI: 10.1093/icvts/ivx422. View

17.

Duncan A, Sarwar S, Kashy B, Sonny A, Sale S, Alfirevic A . Early Left and Right Ventricular Response to Aortic Valve Replacement. Anesth Analg. 2015; 124(2):406-418. PMC: 4945491. DOI: 10.1213/ANE.0000000000001108. View

18.

Gilmanov D, Solinas M, Farneti P, Cerillo A, Kallushi E, Santarelli F . Minimally invasive aortic valve replacement: 12-year single center experience. Ann Cardiothorac Surg. 2015; 4(2):160-9. PMC: 4384246. DOI: 10.3978/j.issn.2225-319X.2014.12.05. View

19.

Unsworth B, Casula R, Kyriacou A, Yadav H, Chukwuemeka A, Cherian A . The right ventricular annular velocity reduction caused by coronary artery bypass graft surgery occurs at the moment of pericardial incision. Am Heart J. 2010; 159(2):314-22. PMC: 2822903. DOI: 10.1016/j.ahj.2009.11.013. View

20.

Kempny A, Diller G, Kaleschke G, Orwat S, Funke A, Schmidt R . Impact of transcatheter aortic valve implantation or surgical aortic valve replacement on right ventricular function. Heart. 2012; 98(17):1299-304. DOI: 10.1136/heartjnl-2011-301203. View