Clinical InvestigationValvular Heart DiseaseImpact of Valvuloarterial Impedance on 2-Year Outcome of Patients Undergoing Transcatheter Aortic Valve Implantation
Section snippets
Patient Population
A total of 116 patients with severe symptomatic aortic stenosis (aortic valve area [AVA] < 1.0 cm2 or transaortic mean pressure gradient ≥ 40 mm Hg) who underwent TAVI at two centers (84 patients at Leiden University Medical Center, Leiden, The Netherlands; 32 patients at the Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, Canada) were included in the present study. Patients who underwent transcatheter valve-in-valve procedures or in whom baseline Zva could
Patient Characteristics
A total of 116 patients with severe symptomatic aortic stenosis (mean age, 81 ± 8 years; 49% men) were evaluated. All patients underwent successful TAVI using a transfemoral (n = 48 [41%]) or transapical (n = 68 [59%]) approach. Thirty-five patients (30%) received 23-mm valve prostheses, and 81 (70%) received 26-mm valves. Clinical and procedural characteristics are outlined in Table 1.
Changes in Aortic Valve Hemodynamics and Global LV Load after TAVI
During the first postoperative month, seven patients (6%) died, and three additional patients died within the
Discussion
The present study showed that TAVI leads to improved valvular hemodynamics, with significant reductions in systolic pressure gradients and increase in AVA, and significant reduction in LV global pressure overload, as measured by Zva. In contrast, systemic arterial compliance and systemic vascular resistance did not change significantly after TAVI. Baseline Zva was independently associated with late outcomes (all-cause mortality) after TAVI.
Conclusions
In patients undergoing TAVI, there is a significant postprocedural reduction in Zva but not in systemic arterial compliance or vascular resistance. High baseline Zva is an independent predictor of increased all-cause mortality at 2-year follow-up. Further studies are needed to identify the role of the routine measurement of Zva for the identification of patients who have a high likelihood to benefit from TAVI.
References (35)
- et al.
Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry
J Am Coll Cardiol
(2011) - et al.
Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience
J Am Coll Cardiol
(2010) - et al.
Impact of left ventricular systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation for severe aortic stenosis
Am Heart J
(2010) - et al.
Hemodynamic results and changes in myocardial function after transcatheter aortic valve implantation
Am Heart J
(2010) - et al.
Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis
J Am Coll Cardiol
(2009) - et al.
Left ventricular mass regression one year after transcatheter aortic valve implantation
Ann Thorac Surg
(2011) - et al.
Influence of concentric left ventricular remodeling on early mortality after aortic valve replacement
Ann Thorac Surg
(2008) - et al.
Impact of size mismatch and left ventricular function on performance of the St. Jude disc valve after aortic valve replacement
Ann Thorac Surg
(1997) - et al.
Impact of the improvement of valve area achieved with aortic valve replacement on the regression of left ventricular hypertrophy in patients with pure aortic stenosis
Ann Thorac Surg
(2005) - et al.
Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment
J Am Coll Cardiol
(2005)
Usefulness of the valvuloarterial impedance to predict adverse outcome in asymptomatic aortic stenosis
J Am Coll Cardiol
The incremental value of valvuloarterial impedance in evaluating the results of transcatheter aortic valve implantation in symptomatic aortic stenosis
J Am Soc Echocardiogr
2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J Am Coll Cardiol
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
Feasibility and initial results of percutaneous aortic valve implantation including selection of the transfemoral or transapical approach in patients with severe aortic stenosis
Am J Cardiol
Low-flow aortic stenosis in asymptomatic patients: valvular-arterial impedance and systolic function from the SEAS Substudy
JACC Cardiovasc Imaging
Hemodynamic and clinical impact of prosthesis-patient mismatch after transcatheter aortic valve implantation
J Am Coll Cardiol
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The Department of Cardiology receives unrestricted research grants from Biotronik (Berlin, Germany), Boston Scientific (Natick, Massachusetts), GE Healthcare (Buckinghamshire, United Kingdom), Medtronic (Minneapolis, Minnesota) and St. Jude Medical (St. Paul, Minnesota). Dr. Delgado received consulting fees from Medtronic and St. Jude Medical. Dr. Katsanos received a grant from the Hellenic Cardiovascular Society.
Dr. Michael Picard is the guest editor for this paper.