Scientific article
English

Acute effects of transcatheter aortic valve replacement on the ventricular-aortic interaction

Published inAmerican journal of physiology. Heart and circulatory physiology, vol. 319, no. 6, p. H1451-H1458
Publication date2020-12-11
First online date2020-10-16
Abstract

Transcatheter aortic valve replacement (TAVR) is increasingly used to treat severe aortic stenosis (AS) patients. However, little is known regarding the direct effect of TAVR on the ventricular-aortic interaction. In the present study, we aimed to investigate changes in central hemodynamics after successful TAVR. We retrospectively examined 33 cases of severe AS patients (84 ± 6 yr) who underwent TAVR. Invasive measurements of left ventricular and aortic pressures as well as echocardiographic aortic flow were acquired before and after TAVR (maximum within 5 days). We examined alterations in key features of central pressure and flow waveforms, including the aortic augmentation index (AIx), and performed wave separation analysis. Arterial parameters were determined via parameter-fitting on a two-element Windkessel model. Resolution of AS resulted in direct increase in the aortic systolic pressure and maximal aortic flow (131 ± 22 vs. 157 ± 25 mmHg and 237 ± 49 vs. 302 ± 69 mL/s, P < 0.001 for all), whereas the ejection duration decreased (P < 0.001). We noted a significant decrease in the AIx (from 42 ± 12 to 19 ± 11%, P < 0.001). Of note, the arterial properties remained unchanged. There was a comparable increase in both forward (61 ± 20 vs. 77 ± 20 mmHg, P < 0.001) and backward (35 ± 14 vs. 42 ± 10 mmHg, P = 0.013) pressure wave amplitudes, while their ratio, i.e., the reflection coefficient, was preserved. Our results highlight the impact of TAVR on the ventricular-aortic interaction by affecting the amplitude, shape, and related attributes of the aortic pressure and flow pulse and challenge the interpretation of AIx as a solely vascular measure in AS patients.

Keywords
  • TAVR
  • Aortic valve replacement
  • Aortic valve stenosis
  • Augmentation index
  • Aged
  • Aged, 80 and over
  • Aorta / physiopathology
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery
  • Arterial Pressure
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Models, Cardiovascular
  • Pulse Wave Analysis
  • Registries
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors
  • Transcatheter Aortic Valve Replacement
  • Treatment Outcome
  • Ventricular Function, Left
  • Ventricular Pressure
Citation (ISO format)
PAGOULATOU, Stamatia et al. Acute effects of transcatheter aortic valve replacement on the ventricular-aortic interaction. In: American journal of physiology. Heart and circulatory physiology, 2020, vol. 319, n° 6, p. H1451–H1458. doi: 10.1152/ajpheart.00451.2020
Main files (1)
Article (Published version)
accessLevelRestricted
Identifiers
Journal ISSN0363-6135
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