Myocardial functional changes in transfemoral versus transapical aortic valve replacement

Area of Science:

• Cardiology
• Medical Imaging
• Cardiac Surgery

Background:

• Severe aortic stenosis (AS) poses significant risks for traditional open-heart surgery.
• Transcatheter aortic valve replacement (TAVR) has emerged as a crucial alternative for high-risk patients.
• Comparing different TAVR approaches is vital for optimizing patient outcomes.

Purpose of the Study:

• To compare myocardial function changes between transfemoral (TF) and transapical (TA) TAVR approaches.
• To evaluate the utility of two-dimensional speckle tracking echocardiography (2DSTE) in assessing TAVR-induced myocardial remodeling.
• To correlate echocardiographic findings with clinical outcomes in TAVR patients.

Main Methods:

• Retrospective analysis of patients undergoing TAVR between 2012-2016.
• Assessment of traditional echocardiographic parameters and 2DSTE-derived myocardial strain and strain rates.
• Comparison of clinical outcomes including mortality, readmission, acute kidney injury, and hospitalization duration.

Main Results:

• Global longitudinal strain significantly improved post-TAVR in the overall cohort.
• Transapical TAVR patients exhibited persistently impaired apical longitudinal strain at 1-month follow-up compared to transfemoral TAVR.
• While short-term clinical outcomes were similar, transapical TAVR was associated with longer hospitalization and ICU stays.

Conclusions:

• Transcatheter aortic valve replacement (TAVR) improves global myocardial function, but the transapical (TA) approach is linked to impaired apical longitudinal strain.
• Two-dimensional speckle tracking echocardiography is a sensitive tool for detecting subtle cardiac remodeling post-TAVR.
• The findings suggest potential differences in myocardial recovery based on TAVR access route, impacting resource utilization.