Myocardial functional changes in transfemoral versus transapical aortic valve replacement

Background: Transcatheter aortic valve replacement (TAVR) has greatly expanded the treatment options available for patients with severe aortic stenosis at high surgical risk. Materials and methods: We compared changes in myocardial function in TAVR with a transfemoral (TF) versus a transapical (TA) approach at a major tertiary hospital from 2012-2016. Traditional echocardiographic measures of cardiac structure and function were tracked, alongside the use of two-dimensional speckle tracking echocardiography to measure myocardial strain and strain rates. Results: For theentire cohort with complete data at all time points(n = 42), between thepre-TAVR baseline (mean: 20.1 d) and the post-TAVR 1-mo follow-up (mean: 32.7 d), global longitudinal strain significantly increased(from - 15.6% to - 18.2%, P < 0.001). When comparing the TF (n = 31) and TA(n = 11) groups, TA patients showed persistently impaired apical longitudinal strain at the 1-mo follow-up (- 15.9% versus - 22.3%, P < 0.05). In terms of clinical outcomes, both groups (n = 131 for TF, n = 53 for TA) were similar interms of 30-dmortality, readmission rate, andrisk of post-TAVR acute kidney injury. However, TA patients experienced significantly longer length of hospitalization(7.58versus 3.92d, P = 0.02), intensive careunit hours (105.4 versus 47.1h, P = 0.02), andwere at a greater risk of long-term (> 72 h) intensive care unit stay (45% versus 25%, P = 0.01). Conclusions: Patients undergoing TA-TAVR exhibit impaired apical longitudinal strain, although global myocardial function is similar to TF-TAVR otherwise. Myocardial strain measured by two-dimensional speckle tracking echocardiography appears to be a sensitive method to detect subtle cardiac remodeling after TAVR. Published by Elsevier Inc.