Sawaya, Fadi

Background: Transcatheter aortic valve replacement (TAVR) is a well-established therapeutic option for all risk patients with symptomatic severe aortic stenosis (AS). While TAVR primarily addresses AS, its benefits extend beyond the valve itself. Recent studies suggest possible restoration of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) following TAVR. This study aims to assess changes in LV GLS in patients undergoing TAVR, which may serve as a subclinical indicator of improved LV mechanics. Materials and Methods: This retrospective study included patients with severe AS who underwent TAVR at the American University of Beirut Medical Center from January 2017 to January 2023. Baseline and 1-year echocardiography parameters were compared, and GLS was calculated to assess the impact of TAVR on LV function. Results: A total of 80 patients (mean age: 81.3 ± 7.8 years; 38.8% of women; 88.8% hypertensive) who underwent TAVR for severe AS were included in the final analysis. One-year post-TAVR, echocardiographic studies showed a significant reduction in interventricular septum diameter (13.3 ± 2.3 mm vs. 12 ± 1.8 mm, P < 0.001) and LV mass index (LVMI) (113.6 ± 26.6 g/m 2 vs. 96 ± 30.3 g/m 2 , P < 0.001). LVEF showed a modest improvement (59.2 ± 12.3% vs. 62.1 ± 7.6%, P < 0.01). LV GLS significantly improved from −16.8 ± 4.6% to −19.2 ± 3.3% ( P < 0.001). Baseline LVMI, LVEF, and GLS correlate with the GLS change (ΔGLS) post-TAVR. Conclusion: GLS significantly improves 1 year after TAVR, indicating an overall improvement in LV performance. The degree of improvement in GLS correlates with baseline LVMI and systolic function.

Background and purpose: Aortic stenosis (AS) poses significant healthcare challenges, particularly in aging populations like Lebanon. Aortic valve replacement (AVR) is the primary treatment; however the choice between transcatheter aortic valve replacement (TAVR) and surgical AVR (SAVR) varies based on patient-specific factors. This study aimed to compare clinical outcomes between TAVR and SAVR in patients with severe AS at a Lebanese tertiary care center. Methods: This retrospective study included 453 patients aged ≥60 with severe AS who underwent either TAVR or SAVR at the American University of Beirut Medical Center from 2011 to 2022. Primary outcomes were 30-day mortality and hospital readmission rates. Secondary outcomes included length of stay, complications, and changes in echocardiographic parameters. Statistical analysis included Chi-squared tests, t-tests, and propensity score matching. Results: Of the 453 patients, 306 underwent TAVR, and 147 underwent SAVR, with a mean age of 79.0 ± 6.8 years. The TAVR group had higher Society of Thoracic Surgeons (STS) scores (4.7 ± 3.2 vs. 2.6 ± 1.7; P < 0.001). TAVR patients had shorter hospital stays (2 [0-93] vs. 6 [4-41] days; P < 0.001), lower 30-day readmission rates (8.2% vs. 18.5%; P = 0.002), and similar all-cause mortality rates (hazard ratio [HR]: 0.69; 95% confidence interval [95% CI]: 0.14–3.42; P = 0.647). Post-procedural new-onset left bundle branch block (LBBB) was more common in TAVR group (13.0% vs. 0.6%; P < 0.001), and new-onset atrial fibrillation (Afib) was more frequent in the SAVR group (34% vs. 1%; P < 0.001). There were no significant differences in the rates of complete heart block (CHB) or pacemaker implantation. The effective orifice area index (EOAi) was higher in the TAVR group (1.2 ± 0.4 vs. 0.9 ± 0.2 cm2/m2; P < 0.001). Major bleeding complications were significantly lower in TAVR patients (7.9% vs. 65.8%; P < 0.001), with no significant differences in neurological events. Conclusions: Both TAVR and SAVR show comparable safety and efficacy, with TAVR offering advantages in terms of recovery time and bleeding risk. These findings support a tailored approach to procedural choice based on individual patient risk profiles.