The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement: insights from PARTNER IIA

Paul C. Cremer, Yiran Zhang, Maria Alu, L. Leonardo Rodriguez, Brian R. Lindman, Alan Zajarias, Rebecca T. Hahn, Stamatios Lerakis, S. Chris Malaisrie, Pamela S. Douglas, Philippe Pibarot, Lars G. Svensson, Martin B. Leon, Wael A. Jaber

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Aims: In patients randomized to transcatheter or surgical aortic valve replacement (TAVR, SAVR), we sought to determine whether SAVR is associated with worsening right ventricular (RV) function and whether RV deterioration is associated with mortality. Methods and results: In 1376 patients from PARTNERIIA with paired baseline and 30-day core lab echocardiograms, worsening RV function was defined as decline by at least one grade from baseline to 30 days. Our primary outcome was all-cause mortality from 30 days to 2 years. Among 744 patients with TAVR, 62 (8.3%) had worsening RV function, compared with 156 of 632 patients with SAVR (24.7%) (P < 0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05, 95% confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95% CI 1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95% CI 1.25-5.33) were associated with worsening RV function. There were 169 deaths, and patients with worsening RV function had higher all-cause mortality [hazard ratio (HR) 1.98, 95% CI 1.40-2.79]. This association remained robust after adjusting for clinical and echocardiographic variables. Among patients with worsening RV function, there was no mortality difference between TAVR and SAVR (HR 1.16, 95% CI 0.61-2.18). The development of moderate or severe RV dysfunction from baseline normal RV function conferred the worst prognosis (HR 2.87, 95% CI 1.40-5.89). Conclusion: After aortic valve replacement, worsening RV function is more common in patients with baseline RV dilation, more than mild TR, and in patients treated with SAVR. Worsening RV function and the magnitude of deterioration have important prognostic implications.

Original languageEnglish
Pages (from-to)2659-2667
Number of pages9
JournalEuropean heart journal
Volume39
Issue number28
DOIs
StatePublished - Jul 21 2018

Fingerprint Dive into the research topics of 'The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement: insights from PARTNER IIA'. Together they form a unique fingerprint.

  • Cite this

    Cremer, P. C., Zhang, Y., Alu, M., Rodriguez, L. L., Lindman, B. R., Zajarias, A., Hahn, R. T., Lerakis, S., Malaisrie, S. C., Douglas, P. S., Pibarot, P., Svensson, L. G., Leon, M. B., & Jaber, W. A. (2018). The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement: insights from PARTNER IIA. European heart journal, 39(28), 2659-2667. https://doi.org/10.1093/eurheartj/ehy251