Differential Impact of Transcatheter and Surgical Aortic Valve Replacement on Right Ventricular Function: A Prospective Cohort Study.

Abstract

Background: Right ventricular (RV) function is an important determinant of outcomes in patients with aortic stenosis (AS) undergoing valve replacement. While transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR), comparative data on RV remodeling in the Indian population remain limited.

Objective: The objective of the study was to evaluate echocardiographic changes in RV function following SAVR and TAVR.

Methods: We conducted a prospective cohort study at a tertiary cardiac center in India between January and December 2024. One hundred consecutive patients with severe AS underwent echocardiography at baseline, immediately postprocedure, and at 6-9-month follow-up. RV function was assessed using tricuspid annular plane systolic excursion (TAPSE), tissue Doppler-derived S', and RV fractional area change (RVFAC), alongside left-sided and hemodynamic parameters.

Results: After TAVR, RV function indices remained stable (TAPSE: 18.3 vs. 18.1 vs. 18.3 mm; S': 10.6 vs. 10.6 vs. 10.8 cm/s; RVFAC: 39.2% vs. 39.0% vs. 40.0%; all P > 0.1). In contrast, SAVR caused an acute decline in TAPSE (19.5-12.8 mm), S' (11.6-7.7 cm/s), and RVFAC (42.0% to 27.6%) immediately postprocedure (all P < 0.001), with only partial recovery at follow-up. Both procedures significantly reduced aortic gradients and pulmonary pressures, with improvements in LV ejection fraction at follow-up.

Conclusions: SAVR is associated with significant perioperative RV dysfunction that remains incompletely reversible, whereas TAVR preserves RV performance while achieving equivalent hemodynamic benefits. Incorporating RV assessment into preprocedural planning and follow-up may enhance patient selection and postoperative care.