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You are here: Contents > 2016 > Volume 25 Number 2 March 2016 > AORTIC VALVE DISEASE > Acute Invasive Hemodynamic Effects of Transcatheter Aortic Valve Replacement

Acute Invasive Hemodynamic Effects of Transcatheter Aortic Valve Replacement

Michael Chrissoheris1, Antonis Ziakas2, Antonis Chalapas1, Stavros Chadjimiltiades2, Ioannis Styliades2, Charalambos Karvounis2, Ioulia Nikolaou1, Konstantinos Spargias1

1Department of Transcatheter Heart Valves, HYGEIA Hospital, Athens, 2University Cardiology Clinic, AHEPA Hospital, Thessaloniki, Greece

Background and aim of the study: Aortic stenosis imposes a chronic pressure overload on the left ventricle, with attendant adaptations in hemodynamics, muscle mass and performance. The hemodynamic changes that occur during the initial 24 h following abrupt removal of the impediment to left ventricular outflow have not been previously examined.

Methods: A total of 52 patients with right heart catheterization was evaluated before, within 6 h and at 24 h after successful transcatheter aortic valve replacement (TAVR). Echocardiographic data were examined before and within 30 days of the procedure.

Results: TAVR was successful in all 52 patients, and at 24 h after the procedure resulted in: (i) an increase in cardiac index (CI) (from 2.0 ± 0.6 to 3.1 ± 0.7 l/min/ m2, p <0.001) and stroke volume (SV) (from 62.3 ± 18.7 to 76.6

± 21.3 ml, p <0.001); (ii) reductions in systemic vascular resistance (from 1555 ± 458 to 1021 ± 280 dyne·s/cm5, p <0.001) and pulmonary vascular resistance (from 174 ± 150 to 112 ± 76 dyne·s/cm5, p = 0.001); (iii) reductions in pulmonary capillary wedge pressure (from 24.2 ± 6.7 to 19.7 ± 7.3 mmHg, p <0.001), mean pulmonary artery pressure (from 32.2 ± 9.9 to 27.5 ± 8.8 mmHg, p = 0.002) and in central venous pressure (from 13.5 ± 4.8 to 9.4 ± 3.9 mmHg, p <0.001); and (iv) an increase in systolic arterial pressure (from 127 ± 25 to 135 ± 14 mmHg, p = 0.04), along with a decrease in diastolic arterial pressure (from 58 ± 11 to 53 ± 9 mmHg, p = 0.009).

Conclusion: Successful TAVR results in immediate and sizeable improvements in SV and CI, reductions in left and right ventricular filling pressures, and marked reductions in systemic and pulmonary vascular resistances.

The Journal of Heart Valve Disease 2016;25:162-172

Acute Invasive Hemodynamic Effects of Transcatheter Aortic Valve Replacement

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