Prognostic assessment of right ventricular systolic dysfunction on post–transcatheter aortic valve replacement short-term outcomes: Systematic review and meta-analysis

• Authors: Salih N. Grevious, Boston University; Marcelo F. Fernandes, Emory University; Ama K. Annor, Baylor College of Medicine; Michel Ibrahim, Boston University; Garly R. Saint Croix, University of Miami; Eduardo de Marchena, University of Miami; Mauricio G. Cohen, University of Miami; Carlos E. Alfonso, University of Miami
• Journal Title: Journal of the American Heart Association
• Volume: Volume 9, Number 12
• Publisher: American Heart Association | 2020-06-16, Pages e014463-e014463
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.119.014463
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management; Health Sciences, Public Health
• Keywords: predictors; prognosis; quality of care; right ventricular dysfunction; transcatheter aortic valve implantation; Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Female; Humans; Male; Risk Assessment; Risk Factors; Severity of Illness Index; Systole; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome; Tricuspid Valve Insufficiency; Ventricular Dysfunction, Right; Ventricular Function, Right

Abstract

Background Right ventricular systolic dysfunction (RVSD) is a known risk factor for adverse outcome in surgical aortic valve replacement. Transcatheter aortic valve replacement (TAVR), on the other hand, has been shown to be either beneficial or have no effect on right ventricular systolic function. However, the prognostic significance of RVSD on TAVR has not been clearly determined. We conducted a systematic review and meta‐analysis to define the impact of RVSD on outcomes in terms of 1‐year mortality in patients with severe aortic stenosis undergoing TAVR. Methods and Results An extensive literature review was performed, with an aim to identify clinical studies that focused on the prognosis and short‐term mortality of patients with severe symptomatic aortic stenosis who underwent TAVR. A total of 3166 patients from 8 selected studies were included. RVSD, as assessed with tricuspid annular plane systolic excursion, fractional area change or ejection fraction, was found to be a predictor of adverse procedural outcome after TAVR (hazard ratio, 1.31; 95% CI, 1.1–1.55; P=0.002). Overall, we found that RVSD did affect post‐TAVR prognosis in 1‐year mortality rate. Conclusions Patients with severe, symptomatic aortic stenosis and concomitant severe RVSD have a poor 1‐year post‐TAVR prognosis when compared with patients without RVSD. Right ventricular dilation and severe tricuspid regurgitation were associated with increased 1‐year morality post‐TAVR and should be considered as independent risk factors. Further evaluations of long‐term morbidity, mortality, as well as sustained improvement in functional class and symptoms need to be conducted to determine the long‐term effects.