Cardiac damage associated with aortic stenosis: comparison between patients treated with surgery and transcatheter aortic valve replacement

Current evidence shows that surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are comparable and equally beneficial in patients with severe aortic stenosis (AS) across different risk profiles.

Our aim was to analyse potential differences in cardiac damage related to AS between patients undergoing SAVR and those treated with TAVR in a contemporary cohort of patients with AS.

Retrospective analysis of a prospective cohort of patients with AS who underwent SAVR or TAVR in a tertiary care center from 2017 to 2022. Clinical and echocardiographic parameters prior to surgery were compared.

Additionally, patients were classified into different categories of available cardiac damage staging systems (1,2).

874 patients were included, of which 524 underwent TAVR and 350 were treated with SAVR. A comparison of epidemiological and echocardiographic features is displayed in the Table.

Patients who underwent TAVR were significantly older and more commonly female.

Regarding echocardiographic features, patients treated with TAVR had lower left ventricular ejection fraction and higher LV mass and left atrium volumes, as well as higher E/’e values. Pulmonary systolic arterial pressures were higher; beside, this group of patients showed lower TAPSE and right ventricular arterial coupling (Figure 1).

When applying two different cardiac damage staging systems in the two cohorts, those patients treated with TAVR had significantly more cardiac damage, with a higher proportion of patients classified into advance stages (Figure 2).

In a contemporary cohort of patients with severe AS, those treated with TAVR had significantly more advance cardiac damage, particularly at the expense of right ventricular damage, compared to those who underwent SAVR.

Earlier treatment before significant cardiac damage takes place may help to improve outcomes.

Echocardiographic characteristics