Background: Right ventricular (RV) performance is an important determinant of prognosis in individuals with advanced aortic stenosis (AS) undergoing aortic valve replacement (AVR). While left ventricular changes after intervention are well described, the trajectory of RV function following surgical AVR (SAVR) and transcatheter aortic valve implantation (TAVI) has not been explored to the same extent. Aim and Objectives: This study aimed to examine serial changes in RV systolic function using multiple echocardiographic indices after AVR in patients with severe AS and to compare the pattern of recovery between SAVR and TAVI. Materials and Methods: A prospective observational study was conducted on 55 patients with severe AS who underwent AVR between April 2023 and March 2025. RV systolic performance was assessed before the procedure and at 6 weeks, 3 months, and 6 months post-intervention. Parameters included tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), RV ejection fraction (RVEF), and RV longitudinal strain (RV LS). Changes over time were analyzed using repeated-measures ANOVA with Bonferroni adjustment for multiple comparisons. Results: Significant improvement in RV systolic indices was observed during follow-up. Mean TAPSE increased from 18.2 ± 2.6 mm at baseline to 20.1 ± 2.4 mm at 6 months (p < 0.001). RV FAC rose from 37.7 ± 5.3% to 41.0 ± 5.0% (p < 0.001), RVEF from 46.8 ± 6.1% to 50.9 ± 5.7% (p = 0.002), and RV LS from −18.1 ± 2.8% to −20.4 ± 2.6% (p < 0.001). Both SAVR and TAVI cohorts demonstrated functional gains; however, patients treated with TAVI exhibited earlier improvement in TAPSE and RV LS at the 6-week assessment. Conclusion: Aortic valve replacement leads to progressive enhancement of RV systolic performance within six months in patients with severe AS. Although both SAVR and TAVI yield meaningful long-term improvement, TAVI appears to facilitate quicker early recovery of RV function.

Aortic stenosis; right ventricular systolic function; aortic valve replacement; transcatheter aortic valve implantation; echocardiography; TAPSE; RV strain; RV fractional area change.