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Changes In Myocardial Work Performance After Surgical And Transcather Aortic Valve Replacement: A Pilot Echocardiographic Study
Srinath Donuru1, Rachad Zayat1, Giulia Musetti2, Nima Hatam1, Rüdiger Autschbach1.
1Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany, 2General Electric Health care, Solingen, Germany.

OBJECTIVE: Postoperative Myocardial injury occurs after surgical aortic valve replacement (sAVR) as well as after transcather aortic valve replacement (TAVR). The novel non-invasive method for regional left ventricular pressure-strain loop area corresponds well with invasive measurements and with directly measured myocardial work (MW). In this pilot study, we aimed to compare changes of LV-MW index (MWI) between sAVR and TAVR in the early postoperative period.
METHODS: 11 TAVR and 12 sAVR patients, who were scheduled for elective procedures received additional transthoracic echocardiography studies pre- and 7 days postoperatively, beside routine measurements of AV and LV parameters following parameters were analysed, MWI, global MW efficiency (MWE), global wasted myocardial work (GWMW), global longitudinal strain (GLS).
RESULTS: In TAVR group, 9 patients had transfermoral (Medtronic Corevalve Evolut R), and 2 patients had transapical access (Symetics Acurate). Patients in sAVR received the perimount bioprosthesis. As expected, EuroSCORE II was significantly higher in the TAVR group (p=0.045). GLS avg. was significantly lower (better) in the sAVR group compared to the TAVR group preoperatively (-14.7±3.5 vs. -11.3+4.1, p=0.035). Postoperative GLS average increased (worsened) in the sAVR group, and no significant difference was detected between the groups (-12.7±5.1% vs. -10.4±3.4%, p=0.215). MWI within TAVR group did not decrease significantly postoperatively (1242 mmHg% vs. 1108 mmHg%, p=0.476). On the other hand, postoperative MWI decreased significantly in the sAVR group (1632 mmHg% vs. 1267 mmHg%, p=0.044). MWI values did not differ preoperatively between sAVR and TAVR groups (p=0.078). GME and GWMW did not differ between the groups or within the groups comparing pre-and postoperative values.
CONCLUSIONS: Despite better GLS in sAVR patients preoperatively, we could detect a better postoperative preservation of global myocardial work in TAVR Patients. Further studies are required to include larger number of patients and perform a correlation with biomarker of postoperative myocardial injury.


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