Prognostic impact of right ventricular dysfunction in patients with severe aortic stenosis treated with trans-catheter aortic valve implantation.

Abstract

Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis (AS), especially in high-risk surgical patients. However, the impact of right ventricular (RV) dysfunction on TAVI outcomes remains unclear. This study aimed to evaluate RV function, measured by tricuspid annular plane systolic excursion (TAPSE), as a predictor of mortality post-TAVI. In a multicenter retrospective cohort study, 637 patients with severe AS who underwent TAVI were assessed for RV function using TAPSE measurements. Data were analyzed to explore the relationship between TAPSE and mortality at 30 days and 1 year, adjusting for demographic factors, comorbidities, and echocardiographic parameters. The prognostic value of the RV-pulmonary artery coupling parameter (TAPSE/PASP) was also investigated. A reduced TAPSE was identified as an independent predictor of 30-day mortality, with each 1-mm increase in TAPSE linked to a 14% reduction in mortality risk (HR 0.86 [95% CI 0.76-0.99]; p = 0.033). The association between TAPSE and 1-year mortality was weaker, with long-term outcomes more strongly influenced by the Charlson Comorbidity Index (CCI) (HR 1.2 [95% CI 1.0-1.3]; p = 0.007). In addition, TAPSE/PASP showed no significant correlation with mortality outcomes. Reduced TAPSE is a valuable predictor of early mortality following TAVI, suggesting that preoperative TAPSE assessments may enhance risk stratification and early post-procedural management. In contrast, long-term mortality in TAVI patients appears to depend more on overall comorbidity burden. Future research should consider integrating TAPSE into risk models to improve individualized TAVI patient care.