Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Research

Background:

• Aortic stenosis (AS) is a common valvular heart disease causing increased afterload, leading to left ventricular (LV) remodeling and fibrosis.
• Transcatheter aortic valve replacement (TAVR) is a key intervention for AS, aiming to alleviate these effects by reducing afterload.

Purpose of the Study:

• To review the literature on the impact of TAVR on LV remodeling and patient outcomes after eliminating AS-related high afterload.
• To assess the reversibility of myocardial fibrosis and the role of LV diastolic dysfunction (LVDD) post-TAVR.

Main Methods:

• Literature review of studies investigating TAVR's effects on LV remodeling and patient outcomes.
• Analysis of factors influencing post-TAVR mortality, including LVDD severity and post-procedural aortic regurgitation (AR).

Main Results:

• TAVR effectively reduces afterload and improves LV remodeling, but myocardial fibrosis may not fully reverse.
• LV diastolic dysfunction (LVDD) is an independent predictor of post-TAVR mortality, with increased risk correlating to LVDD severity.
• Even minimal post-TAVR AR can worsen survival in patients with severe baseline LVDD.

Conclusions:

• Early TAVR intervention before advanced LVDD development is crucial for optimal patient outcomes.
• Mitigating post-TAVR AR through appropriate device selection and deployment is vital for improving survival.
• LVDD significantly impacts mid-term and long-term patient survival following TAVR.