echocardiographic evaluation of cardiac function response to removal of aortic stenosis: surgical and trans-catheter aortic valve implantation (tavi)

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.