Key result
TAVI linked to an immediate ~9% drop in LVEF, indicating impaired early systolic function.
Why the study?
The hemodynamic changes occurring immediately after transcatheter aortic valve implantation are poorly understood.
Does transcatheter aortic valve implantation alter early hemodynamic parameters in patients with severe aortic stenosis?
Observational (n=8)
No
Does transcatheter aortic valve implantation alter early hemodynamic parameters in patients with severe aortic stenosis?
Absolute Event Rate: 44.8% vs 53.9%
p-value: p=0.018
Invasive pressure volume loop analysis reveals that immediately after TAVI, patients experience impaired systolic and diastolic function despite an early improvement in global cardiovascular energy efficiency.
Early post-TAVI systolic impairment warrants monitoring but should not change practice; leaves open long-term recovery and outcomes.
Replacement of a stenotic aortic valve reduces immediately the ventricular to aortic gradient and is expected to improve diastolic and systolic left ventricular function over the long term. However, the hemodynamic changes immediately after valve implantation are so far poorly understood. Within this pilot study, we performed an invasive pressure volume loop analysis to describe the early hemodynamic changes after transcatheter aortic valve implantation (TAVI) with self-expandable prostheses. Invasive left ventricular pressure volume loop analysis was performed in 8 patients with aortic stenosis (mean 81.3 years) prior and immediately after transfemoral TAVI with a self-expandable valve system (St. Jude Medical Portico Valve). Parameters for global hemodynamics, afterload, contractility and the interaction of the cardiovascular system were analyzed. Left ventricular ejection fraction, (53.9% vs. 44.8%, p = 0.018), preload recruitable stroke work (68.5 vs. 44.8 mmHg, p = 0.012) and end-systolic elastance (3.55 vs. 2.17, p = 0.036) both marker for myocardial contractility declined significantly compared to baseline. As sign of impaired diastolic function, TAU, a preload-independent measure of isovolumic relaxation (37.3 vs. 41.8 ms, p = 0.018) and end-diastolic pressure (13.1 vs. 16.4 mmHg, p = 0.015) raised after valve implantation. Contrarily, a smaller ratio of end-systolic to arterial elastance (ventricular-arterial coupling) indicates an improvement of global cardiovascular energy efficiency (1.40 vs. 0.97 p = 0.036). Arterial elastance had a strong correlation with the number of conducted rapid ventricular pacings (Pearson correlation coefficient, r = 0.772, p = 0.025). Invasive left ventricular pressure volume loop analysis revealed impaired systolic and diastolic function in the early phase after TAVI with self-expandable valve for the treatment of severe aortic stenosis. Contrarily, we found indications for early improvement of global cardiovascular energy efficiency.
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Seppelt et al. (2020) conducted an observational in Severe aortic stenosis (n=8). Transcatheter aortic valve implantation (TAVI) with self-expandable prostheses vs. Baseline (pre-TAVI) was evaluated on Left ventricular ejection fraction (p=0.018). Immediately after transcatheter aortic valve implantation, left ventricular ejection fraction significantly declined from 53.9% to 44.8%, indicating impaired early systolic function.
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