Abstract 17222: Surgical as Opposed to Transcatheter Aortic Valve Replacement for Aortic Stenosis Improves Associated Basal Septal Hypertrophy/Dysfunction
Background: Basal interventricular septal (IVS) hypertrophy (BSH) is frequently associated with aortic stenosis (AS) and its mechanism is not established. The shape of BSH suggests the possibility of compression from longitudinally elongated ascending aorta, causing regional dysfunction of the BSH (left upper figure). Surgical aortic valve replacement (SAVR), as opposed to transcatheter AVR (TAVR), may potentially improve BSH by shortening longitudinal length of the aorta by incision and stitching (right upper figure). We hypothesized that basal IVS thickness as well as its contraction improves after SAVR, as opposed to TAVR, in patients with AS and associated BSH.
Methods: In 32 patients with SAVR and 12 with TAVR to AS, regional wall thickness and systolic contraction (longitudinal strain) of 12 LV segments as well as IVS to aorta angle were measured by echocardiography.
Results: After SAVR, basal IVS thickness and its contraction significantly improved (13.5±3.5 to 12.2±2.6 mm, -6.2±5.7 to -9.1±5.2 %, p<0.001, respectively) (lower figures) and other 11 segments tended to improve but without statistical significance. IVS to aorta angle also significantly improved (115±22 to 123±14 degree, p<0.001). These regional improvements in basal IVS were correlated with pre-operative degree of basal IVS hypertrophy (IVS to posterior wall thickness ratio or IVS to aorta angle: r=0.65 and 0.37, p<0.05, respectively). These regional improvements of basal IVS were not observed following TAVR.
Conclusions: In patients with AS, SAVR as opposed to TAVR improves associated basal IVS hypertrophy and its functional impairment.
Author Disclosures: H. Yoshitani: None. J. Song: None. J. Jang: None. Y. Nagata: None. M. Toki: None. B. Sun: None. S. Fukuda: None. D. Kim: None. N. Kagiyama: None. A. Hayashi: None. T. Miyamoto: None. A. Hayashida: None. J. Song: None. Y. Oginosawa: None. S. Sonoda: None. M. Takeuchi: None. K. Yoshida: None. R. Levine: None. Y. Otsuji: None.
- © 2016 by American Heart Association, Inc.