Effect of transcatheter aortic valve replacement on postoperative left ventricular reverse remodeling in patients with aortic regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Xing ¹ , JIANG Zhaolei ¹ ,  MEI Ju ¹ , HUANG Jianbing ¹ , DING Fangbao ¹ , TANG Min ¹ , LIU Hao ¹ , CAI Jie ¹ , SHEN Sai’e ²

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092,P. R. China;
2. Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;

Corresponding author：

MEI Ju, Email: ju_mei63@126.com

Keywords：

Transcatheter aortic valve replacement; aortic valve insufficiency; left ventricular reverse remodeling

DOI：

10.7507/1007-4848.202301041

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Objective To investigate the left ventricular reverse remodeling (LVRR) in patients with aortic valve insufficiency with reduced ejection fraction (AIrEF) and aortic valve insufficiency with preserved ejection fraction (AIpEF) after transcatheter aortic valve replacement (TAVR). Methods The clinical and follow-up data of patients who underwent TAVR in the Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2018 to 2021 were retrospectively analyzed. According to the guideline, the patients with left ventricular ejection fraction<55% were allocated to an AIrEF group, and the patients with left ventricular ejection fraction≥55% were allocated to an AIpEF group. Results A total of 50 patients were enrolled. There were 19 patients in the AIrEF group, including 15 males and 4 females with a mean age of 74.5±7.1 years. There were 31 patients in the AIpEF group, including 19 males and 12 females with a mean age of 72.0±4.8 years. All patients underwent TAVR successfully. Echocardiographic results showed that TAVR significantly promoted LVRR in the patients. Significant LVRR occurred in the early postoperative period (the first day after the surgery) in both groups. It remained relatively stable after the LVRR in the early postoperative period (the first day after surgery) in the AIpEF patients, while it continued to occur in the early postoperative period (the first day after surgery) to three months after the surgery in the AIrEF patients, and then remained relatively stable. Compared to preoperative values, AIrEF patients had a reduction in the average left ventricular end-diastolic volume index and left ventricular end-systolic volume index by 16.8 mL/m² (P=0.003) and 8.6 mL/m² (P=0.005), respectively, and the average left ventricular end-diastolic diameter index and end-systolic diameter index decreased by 2.5 mm/m² (P=0.003) and 1.9 mm/m² (P=0.003), respectively on the first day after the surgery. In comparison to the first day after the surgery, AIrEF patients experienced an average increase of 12.1% in the left ventricular ejection fraction three months after the surgery (P＜0.001). Conclusion TAVR has achieved good therapeutic effects in patients with aortic valve insufficiency, significantly promoting the LVRR in patients, and has better curative effects in AIrEF patients.

Citation： ZHAO Xing, JIANG Zhaolei, MEI Ju, HUANG Jianbing, DING Fangbao, TANG Min, LIU Hao, CAI Jie, SHEN Sai’e. Effect of transcatheter aortic valve replacement on postoperative left ventricular reverse remodeling in patients with aortic regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1121-1127. doi: 10.7507/1007-4848.202301041 Copy

1.	姜兆磊, 梅举, 汤敏, 等. “一站式”左心耳夹闭术联合经导管主动脉瓣置换术治疗主动脉瓣病变合并心房颤动. 中国胸心血管外科临床杂志, 2022, 29(5): 560-564.
2.	Spears J, Al-Saiegh Y, Goldberg D, et al. TAVR: A review of current practices and considerations in low-risk patients. J Interv Cardiol, 2020, 2020: 2582938.
3.	Avvedimento M, Tang GHL. Transcatheter aortic valve replacement (TAVR): Recent updates. Prog Cardiovasc Dis, 2021, 69: 73-83.
4.	Rudziński PN, Mach M, Gross C, et al. Complex transcatheter aortic valve replacement in aortic regurgitation and transcatheter mitral annuloplasty in severe dextrocardia. Eur J Cardiothorac Surg, 2021, 60(4): 997-999.
5.	Tarantini G, Rodinò G. Transcatheter aortic valve replacement for native and prosthetic aortic regurgitation: Two birds with one stone. Catheter Cardiovasc Interv, 2022, 99(5): 1609-1610.
6.	Koch R, Inci E, Grubb K, et al. A comparison of thirty-day clinical and echocardiographic outcomes of patients undergoing transcatheter vs. surgical aortic valve replacement for native aortic insufficiency. Cardiovasc Revasc Med, 2023, 46: 85-89.
7.	Burchfield JS, Xie M, Hill JA. Pathological ventricular remodeling: Mechanisms: Part 1 of 2. Circulation, 2013, 128(4): 388-400.
8.	Wong M, Staszewsky L, Latini R, et al. Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan heart failure trial (Val-HeFT) echocardiographic data. J Am Coll Cardiol, 2004, 43(11): 2022-2027.
9.	Parikh PB, Tsigkas G, Kalogeropoulos AP. Transcatheter aortic valve replacement after heart failure hospitalization: Too little, too late? Eur J Heart Fail, 2020, 22(10): 1875-1877.
10.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-e1195.
11.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
12.	Barth M, Selig JI, Klose S, et al. Degenerative aortic valve disease and diabetes: Implications for a link between proteoglycans and diabetic disorders in the aortic valve. Diab Vasc Dis Res, 2019, 16(3): 254-269.
13.	Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
14.	Lindman BR, Arnold SV, Bagur R, et al. Priorities for patient-centered research in valvular heart disease: A report from the National Heart, Lung, and Blood Institute Working Group. J Am Heart Assoc, 2020, 9(9): e015975.
15.	Nakatsuma K, Taniguchi T, Morimoto T, et al. B-type natriuretic peptide in patients with asymptomatic severe aortic stenosis. Heart, 2019, 105(5): 384-390.
16.	Bergler-Klein J, Klaar U, Heger M, et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation, 2004, 109(19): 2302-2308.
17.	Lai HC, Lai HC, Lee WL, et al. Impact of chronic advanced aortic regurgitation on the perioperative outcome of noncardiac surgery. Acta Anaesthesiol Scand, 2010, 54(5): 580-588.
18.	Hashimoto G, Enriquez-Sarano M, Stanberry LI, et al. Association of left ventricular remodeling assessment by cardiac magnetic resonance with outcomes in patients with chronic aortic regurgitation. JAMA Cardiol, 2022, 7(9): 924-933.
19.	Matsumura Y, Hoshikawa-Nagai E, Kubo T, et al. Left ventricular reverse remodeling in long-term (>12 years) survivors with idiopathic dilated cardiomyopathy. Am J Cardiol, 2013, 111(1): 106-110.
20.	Barfuss SB, Boucek DM, McFarland CA, et al. Short-term left ventricular reverse remodeling after transcatheter aortic valve replacement in children. J Am Soc Echocardiogr, 2022, 35(10): 1077-1083.

1. 姜兆磊, 梅举, 汤敏, 等. “一站式”左心耳夹闭术联合经导管主动脉瓣置换术治疗主动脉瓣病变合并心房颤动. 中国胸心血管外科临床杂志, 2022, 29(5): 560-564.
2. Spears J, Al-Saiegh Y, Goldberg D, et al. TAVR: A review of current practices and considerations in low-risk patients. J Interv Cardiol, 2020, 2020: 2582938.
3. Avvedimento M, Tang GHL. Transcatheter aortic valve replacement (TAVR): Recent updates. Prog Cardiovasc Dis, 2021, 69: 73-83.
4. Rudziński PN, Mach M, Gross C, et al. Complex transcatheter aortic valve replacement in aortic regurgitation and transcatheter mitral annuloplasty in severe dextrocardia. Eur J Cardiothorac Surg, 2021, 60(4): 997-999.
5. Tarantini G, Rodinò G. Transcatheter aortic valve replacement for native and prosthetic aortic regurgitation: Two birds with one stone. Catheter Cardiovasc Interv, 2022, 99(5): 1609-1610.
6. Koch R, Inci E, Grubb K, et al. A comparison of thirty-day clinical and echocardiographic outcomes of patients undergoing transcatheter vs. surgical aortic valve replacement for native aortic insufficiency. Cardiovasc Revasc Med, 2023, 46: 85-89.
7. Burchfield JS, Xie M, Hill JA. Pathological ventricular remodeling: Mechanisms: Part 1 of 2. Circulation, 2013, 128(4): 388-400.
8. Wong M, Staszewsky L, Latini R, et al. Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan heart failure trial (Val-HeFT) echocardiographic data. J Am Coll Cardiol, 2004, 43(11): 2022-2027.
9. Parikh PB, Tsigkas G, Kalogeropoulos AP. Transcatheter aortic valve replacement after heart failure hospitalization: Too little, too late? Eur J Heart Fail, 2020, 22(10): 1875-1877.
10. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017, 135(25): e1159-e1195.
11. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
12. Barth M, Selig JI, Klose S, et al. Degenerative aortic valve disease and diabetes: Implications for a link between proteoglycans and diabetic disorders in the aortic valve. Diab Vasc Dis Res, 2019, 16(3): 254-269.
13. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
14. Lindman BR, Arnold SV, Bagur R, et al. Priorities for patient-centered research in valvular heart disease: A report from the National Heart, Lung, and Blood Institute Working Group. J Am Heart Assoc, 2020, 9(9): e015975.
15. Nakatsuma K, Taniguchi T, Morimoto T, et al. B-type natriuretic peptide in patients with asymptomatic severe aortic stenosis. Heart, 2019, 105(5): 384-390.
16. Bergler-Klein J, Klaar U, Heger M, et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation, 2004, 109(19): 2302-2308.
17. Lai HC, Lai HC, Lee WL, et al. Impact of chronic advanced aortic regurgitation on the perioperative outcome of noncardiac surgery. Acta Anaesthesiol Scand, 2010, 54(5): 580-588.
18. Hashimoto G, Enriquez-Sarano M, Stanberry LI, et al. Association of left ventricular remodeling assessment by cardiac magnetic resonance with outcomes in patients with chronic aortic regurgitation. JAMA Cardiol, 2022, 7(9): 924-933.
19. Matsumura Y, Hoshikawa-Nagai E, Kubo T, et al. Left ventricular reverse remodeling in long-term (>12 years) survivors with idiopathic dilated cardiomyopathy. Am J Cardiol, 2013, 111(1): 106-110.
20. Barfuss SB, Boucek DM, McFarland CA, et al. Short-term left ventricular reverse remodeling after transcatheter aortic valve replacement in children. J Am Soc Echocardiogr, 2022, 35(10): 1077-1083.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of transcatheter aortic valve replacement on postoperative left ventricular reverse remodeling in patients with aortic regurgitation

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