Distal aortic biomechanics after transcatheter versus surgical aortic valve replacement: a hypothesis generating study.

TitleDistal aortic biomechanics after transcatheter versus surgical aortic valve replacement: a hypothesis generating study.
Publication TypeJournal Article
Year of Publication2023
AuthorsRong LQ, Zheng W, Martinez A, Rahouma M, Devereux RB, Kim J, Osman B, Palumbo MC, Redfors B, Girardi LN, Weinsaft JW, Gaudino M
JournalJ Cardiothorac Surg
Date Published2023 Nov 30
KeywordsAged, 80 and over, Aortic Valve, Aortic Valve Stenosis, Biomechanical Phenomena, Female, Heart Valve Prosthesis Implantation, Humans, Male, Risk Factors, Transcatheter Aortic Valve Replacement, Treatment Outcome

BACKGROUND: Biomechanical effects of transcatheter (TAVR) versus surgical (SAVR) aortic valve interventions on the distal aorta have not been studied. This study utilized global circumferential strain (GCS) to assess post-procedural biomechanics changes in the descending aorta after TAVR versus SAVR.

METHODS: Patients undergoing TAVR or SAVR for aortic stenosis were included. Transesophageal (TEE) and transthoracic (TTE) echocardiography short-axis images of the aorta were used to image the descending aorta immediately before and after interventions. Image analysis was performed with two-dimensional speckle tracking echocardiography and dedicated software. Delta GCS was calculated as: post-procedural GCS-pre-procedural GCS. Percentage delta GCS was calculated as: (delta GCS/pre-procedural GCS) × 100.

RESULTS: Eighty patients, 40 TAVR (median age 81 y/o, 40% female) and 40 SAVR (median 72 y/o, 30% female) were included. The post-procedure GCS was significantly higher than the pre-procedural GCS in the TAVR (median 10.7 [interquartile range IQR 4.5, 14.6] vs. 17.0 [IQR 6.1, 20.9], p = 0.009) but not in the SAVR group (4.4 [IQR 3.3, 5.3] vs. 4.7 [IQR 3.9, 5.6], p = 0.3). The delta GCS and the percentage delta GCS were both significantly higher in the TAVR versus SAVR group (2.8% [IQR 1.4, 6] vs. 0.15% [IQR - 0.6, 1.5], p < 0.001; and 28.8% [IQR 14.6%, 64.6%] vs. 4.4% [IQR - 10.6%, 5.6%], p = 0.006). Results were consistent after multivariable adjustment for key clinical and hemodynamic characteristics.

CONCLUSIONS: After TAVR, there was a significantly larger increase in GCS in the distal aorta compared to SAVR. This may impact descending aortic remodeling and long-term risk of aortic events.

Alternate JournalJ Cardiothorac Surg
PubMed ID38037164
PubMed Central IDPMC10690972
Grant ListK23 153836 / / National Institutes of Health (NIH), National Heart Blood and Lung Institute /