Comparing Cardiac Reverse Remodeling in Aortic Stenosis With Surgical and Transcatheter Aortic Valve Replacement.

Background: Left ventricular reverse remodeling, which is synonymous left ventricular mass regression, after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) is associated with positive clinical outcomes in patients with aortic stenosis. However, the roles of SAVR and TAVR in left ventricular mass regression remain unclear. This study compared the left ventricular mass change between SAVR and TAVR. Methods: Included were 1939 patients with aortic stenosis who underwent isolated SAVR or TAVR, and 1:1 propensity matching was performed (247 pairs). The primary outcome was the time course change of left ventricular mass between SAVR and TAVR. Left ventricular mass regression was evaluated and calculated up to 1 year of follow-up by echocardiography. Results: In a matched cohort, SAVR demonstrated better left ventricular mass regression compared with TAVR at 30 days (SAVR vs TAVR: mean, -11.2% [95% CI, -13.4% to -8.9%] vs mean, -2.6% [95% CI, -5.0% to -0.4%], P < .01) and at 1 year (SAVR vs TAVR: mean -23.8% [95% CI, - 26.0% to -21.6%) vs -13.8% [95% CI, -16.6% to -11.0%], P < .01). In multivariable analysis, baseline left ventricular mass index (odds ratio, 1.04; 95% CI, 1.03-1.05; P < .01), SAVR choice (odds ratio, 2.54; 95% CI, 1.46-4.43; P < .01), and paravalvular leakage mild or more (odds ratio, 0.61; 95% CI, 0.44-0.84; P < .01) were associated with left ventricular mass regression. Conclusions: SAVR demonstrated better left ventricular mass regression than TAVR in a matched cohort. Considering the lifetime management of the patients, selecting the optimal valve is crucial.