Impact of Transcatheter Aortic Valve Implantation on Right Ventricular Function

The prevalence and predictors of right ventricular (RV) dysfunction before and after transcatheter aortic valve implantation (TAVI) are not known. We aimed to document this and sought to identify specific RV echo thresholds, below which RV improvement was unlikely to occur.

Consecutive patients who underwent TAVI between 2017 and 2021 at Macquarie University Hospital (MUH) were included if ≥2 RV functional parameters were available on baseline echo; tricuspid annular plane systolic excursion, tissue Doppler (S') and/or RV fractional area change. Prevalence and predictors of baseline RV dysfunction were documented. Patients with a repeat echo performed at MUH at 1-3 months post-TAVI were included in further analyses to assess serial changes in RV function.

Overall, 343 patients had an eligible baseline echo and 97 of these patients (28.2%) had RV dysfunction, pre-TAVI. These patients had significantly higher rates of atrial fibrillation, ischaemic heart disease, and chronic lung disease, than those without (p<0.05 for all). Of 239 patients with 1-3 month follow-up echo data, 66 of these had had baseline RV dysfunction; of these, 20 (30.3%) patients showed improvement and 46 (69.7%) patients showed persistent RV dysfunction. Thresholds with a greater than 90% predictive value for persistent RV dysfunction were identified for each baseline RV functional parameter: tricuspid annular plane systolic excursion <1.4 cm, S'<6, fractional area change <25%.

Baseline RV dysfunction was present in over a quarter of pre-TAVI patients and persisted at short-term follow-up in over two-thirds of such patients. There were clear thresholds to identify patients where RV recovery was unlikely, after TAVI.