Echocardiographic evaluation of cardiac function response to removal of aortic stenosis: Surgical and trans-catheter aortic valve implantation (TAVI)

Abstract

Aortic stenosis (AS) is the commonest valve disease in the

West, with a prevalence varying between 0.02% in adults

under 44 years and 3-9% in those over 80 years of age 1, 2. The

disease may remain “silent” and hence unnoticed for years,

particularly in the elderly with naturally limited exercise. With the

development of symptoms, patients may carry a mortality of

36-52%, 52-80% and 80-90% at 3, 5 and 10 years, respectively

if left untreated, with a potential high risk of sudden death 3.

Surgical aortic valve replacement (SAVR) used to be the only

effective treatment for severe AS, being the second indication

for open heart surgery after coronary artery bypass grafting

(CABG) 4. Trans-catheter aortic valve implantation (TAVI) is a

recently developed procedure which aims at non-surgical AVR

in patients with severe, symptomatic and calcified AS who

are at high surgical risk because of either poor left ventricular

(LV) function, ejection fraction (EF) <50%, or other significant

co-morbidities e.g. age >80 years, previous CABG surgery and/

or aorta or other heart valve surgery, impaired kidney function,

chronic obstructive pulmonary disease (COPD) or pulmonary

hypertension 5. Currently, this technique is not recommended

in bicuspid AS patients due to the risk of incomplete and

suboptimal deployment of the aortic prosthesis [6]. TAVI

avoids open heart surgery and hence is likely to protect

myocardial function. The purpose of this paper is to review the

echocardiographic evaluation of LV, right ventricular (RV), and

left atrial (LA) function response to SAVR and TAVI for AS.