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

• Published in: Journal of cardiothoracic surgery 2023-11, Vol.18 (1), p.1-349, Article 349
• Main Authors: Rong, Lisa Q., Zheng, William, Martinez, Andrew, Rahouma, Mohammed, Devereux, Richard B., Kim, Jiwon, Osman, Bassam, Palumbo, Maria C., Redfors, Björn, Girardi, Leonard N., Weinsaft, Jonathan W., Gaudino, Mario
• Format: Article
• Language: English
• Subjects: Analysis of covariance; Aorta; Aortic stenosis; Aortic strain; Aortic valve; Aortic valve stenosis; Biomechanics; Blood pressure; Cardiology and Cardiovascular Disease; Coronary vessels; Echocardiography; Females; Heart valves; Hemodynamics; Hypotheses; Image analysis; Image processing; Kardiologi och kardiovaskulära sjukdomar; Mathematical analysis; Patients; Pulmonary arteries; Sensitivity analysis; Software; Surgical aortic valve replacement; Transcatheter aortic valve replacement; Transesophageal echocardiography; Two dimensional analysis; Variables
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-023-02467-z

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) x 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. Keywords: Aortic strain, Transesophageal echocardiography, Surgical aortic valve replacement, Transcatheter aortic valve replacement