Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR
© 2023. The Author(s)..
INTRODUCTION: During the transcatheter aortic valve replacement (TAVR) procedure, hemodynamic measurements can be used to evaluate transcatheter heart valve (THV) performance. We hypothesized that the occurrence of a significant decrease in invasive aortic pressure immediately after annular contact by a self-expanding THV indicates effective annular sealing. This phenomenon could thus be used as a marker for the occurrence of paravalvular leak (PVL).
METHODS: Thirty-eight patients undergoing TAVR procedure with a self-expandable Evolut R or Evolut Pro (Medtronic) valve prosthesis were included in the study. Drop in aortic pressure during valve expansion was defined as a decrease in systolic pressure of 30 mmHg immediately after annular contact. The primary endpoint was the occurrence of more than mild PVL immediately after valve implantation.
RESULTS: A pressure drop was seen in 60.5% (23/38) of patients. More than mild PVL requiring balloon post-dilatation (BPD) was significantly more frequent in patients who did not have a systolic pressure decrease > 30 mmHg during valve implantation (46.7% [7/15] vs. 13.0% [3/23], respectively; p = 0.03). Patients without a systolic pressure decrease > 30 mmHg also had a lower mean cover index on computed tomography analysis (16.2% vs. 13.3%; p = 0.016). The 30-day outcomes were similar between the two groups, and echocardiography at 30 days demonstrated more than none/trace PVL in 21.1% (8/38) of patients, with no difference between the two groups.
CONCLUSION: A decrease in aortic pressure after annular contact is associated with an increased probability of good hemodynamic outcome after self-expanding TAVR implantation. In addition to other methods, this parameter could be used as an additional marker for optimal valve positioning and hemodynamic outcome during the implantation procedure.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Cardiology and therapy - 12(2023), 2 vom: 11. Juni, Seite 361-369 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pykäri, Jouni [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic stenosis |
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| Anmerkungen: |
Date Revised 18.07.2023 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1007/s40119-023-00307-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 520 | |a © 2023. The Author(s). | ||
| 520 | |a INTRODUCTION: During the transcatheter aortic valve replacement (TAVR) procedure, hemodynamic measurements can be used to evaluate transcatheter heart valve (THV) performance. We hypothesized that the occurrence of a significant decrease in invasive aortic pressure immediately after annular contact by a self-expanding THV indicates effective annular sealing. This phenomenon could thus be used as a marker for the occurrence of paravalvular leak (PVL) | ||
| 520 | |a METHODS: Thirty-eight patients undergoing TAVR procedure with a self-expandable Evolut R or Evolut Pro (Medtronic) valve prosthesis were included in the study. Drop in aortic pressure during valve expansion was defined as a decrease in systolic pressure of 30 mmHg immediately after annular contact. The primary endpoint was the occurrence of more than mild PVL immediately after valve implantation | ||
| 520 | |a RESULTS: A pressure drop was seen in 60.5% (23/38) of patients. More than mild PVL requiring balloon post-dilatation (BPD) was significantly more frequent in patients who did not have a systolic pressure decrease > 30 mmHg during valve implantation (46.7% [7/15] vs. 13.0% [3/23], respectively; p = 0.03). Patients without a systolic pressure decrease > 30 mmHg also had a lower mean cover index on computed tomography analysis (16.2% vs. 13.3%; p = 0.016). The 30-day outcomes were similar between the two groups, and echocardiography at 30 days demonstrated more than none/trace PVL in 21.1% (8/38) of patients, with no difference between the two groups | ||
| 520 | |a CONCLUSION: A decrease in aortic pressure after annular contact is associated with an increased probability of good hemodynamic outcome after self-expanding TAVR implantation. In addition to other methods, this parameter could be used as an additional marker for optimal valve positioning and hemodynamic outcome during the implantation procedure | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Aortic stenosis | |
| 650 | 4 | |a Balloon post-dilatation | |
| 650 | 4 | |a PVL | |
| 650 | 4 | |a TAVR | |
| 700 | 1 | |a Vasankari, Tuija |e verfasserin |4 aut | |
| 700 | 1 | |a Ylitalo, Antti |e verfasserin |4 aut | |
| 700 | 1 | |a Porela, Pekka |e verfasserin |4 aut | |
| 700 | 1 | |a Paana, Tuomas |e verfasserin |4 aut | |
| 700 | 1 | |a Malmberg, Markus |e verfasserin |4 aut | |
| 700 | 1 | |a Laurila, Sanna |e verfasserin |4 aut | |
| 700 | 1 | |a Koskinen, Juho |e verfasserin |4 aut | |
| 700 | 1 | |a Koivisto, Tero |e verfasserin |4 aut | |
| 700 | 1 | |a Savontaus, Mikko |e verfasserin |4 aut | |
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