Immediate change following valve deployment in left ventricular systolic and diastolic functions in transcatheter aortic valve replacement: a retrospective cohort study

Yuri Hayashi; Ryuichiro Miyake; Gardar Sigurdsson; Kenichi Ueda; Satoshi Hanada

doi:10.21037/jtd-24-784

Immediate change following valve deployment in left ventricular systolic and diastolic functions in transcatheter aortic valve replacement: a retrospective cohort study

J Thorac Dis. 2024 Sep 30;16(9):5643-5649. doi: 10.21037/jtd-24-784. Epub 2024 Sep 11.

Authors

Yuri Hayashi^{1

2}, Ryuichiro Miyake³, Gardar Sigurdsson⁴, Kenichi Ueda^{1

5}, Satoshi Hanada¹

Affiliations

¹ Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
² Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
³ Department of Anesthesia, Takatsuki General Hospital, Takatsuki, Osaka, Japan.
⁴ Iowa Heart Center MercyOne, Des Moines, IA, USA.
⁵ Department of Anesthesiology, Kameda Medical Center, Kamogawa, Japan.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is an effective treatment for aortic valve disorder. Several studies have reported improvements in systolic and diastolic function following TAVR. However, few studies have addressed immediate post-deployment changes. Therefore, this study examines left ventricular (LV) systolic and diastolic function changes immediately after valve deployment in TAVR patients, distinguishing between those with normal and impaired LV ejection fraction (LVEF).

Methods: In this single-center retrospective cohort study, intraoperative changes in LV systolic and diastolic function were analyzed in patients undergoing TAVR from January 2012 to September 2014. Participants were categorized into two groups based on preprocedural LVEF: the low ejection fraction (EF) group (LVEF <50%) and the normal EF group (LVEF ≥50%). LVEF, as an indicator of LV systolic function, along with lateral e' and the E/e' ratio as indicators of LV diastolic function before and immediately after valve deployment were compared in the overall cohort and within each group.

Results: Forty-eight TAVR cases were included, comprising 15 in the low EF group and 33 in the normal EF group. Overall, there was a significant improvement in LVEF {51.7% [standard deviation (SD)] 15.0 vs. 58.0% (SD 11.6), P=0.007}, with no significant changes in e' or E/e'. In the low EF group, a significant increase was observed in LVEF [31.8% (SD 8.0) vs. 45.5% (SD 9.9), P=0.006], e' [5.0 cm/s (SD 1.4) vs. 6.2 cm/s (SD 1.0), P=0.004], and a significant decrease was observed in E/e' [22.3 (SD 7.6) vs. 16.1 (SD 3.4), P=0.01]. The normal EF group showed a significant decrease in e' [6.2 cm/s (SD 1.8) vs. 5.9 cm/s (SD 1.6), P=0.04] without significant changes in LVEF and E/e'.

Conclusions: This study revealed significant intraoperative improvements in systolic and diastolic functions immediately after valve deployment in TAVR patients with low preprocedural LVEF. These immediate improvements were not observed in patients with normal LVEF.

Keywords: Transcatheter aortic valve replacement (TAVR); left ventricular diastolic function; left ventricular systolic function; low ejection fraction.