Key result
CoreValve TAVI linked to ~160% increase in aortic valve area post-procedure.
Why the study?
The beneficial effects of TAVI on cardiac hemodynamics have been described mostly after more than 6 months, but acute and short-term alterations remain to be investigated.
Does TAVI with the CoreValve system improve acute and short-term echocardiographic hemodynamic parameters in high-risk patients with aortic stenosis?
Observational (n=60)
Does TAVI with the CoreValve system improve acute and short-term echocardiographic hemodynamic parameters in high-risk patients with aortic stenosis?
TAVI with the CoreValve system provides immediate and short-term (3-month) improvements in cardiac hemodynamics, including increased aortic valve area, reduced gradients, and favorable left ventricular reverse remodeling.
Answers are grounded in this paper and cite their sources.
Supports acute CoreValve TAVI efficacy in small series; leaves open durability and outcome data.
BACKGROUND AND AIMS: Transcatheter aortic valve implantation (TAVI) is an established method for the treatment of high-risk patients with aortic stenosis (AS). The beneficial effects of TAVI in cardiac hemodynamics have been described in recent studies, but those investigations were mostly performed after an interval of more than 6 months following aortic valve implantation. The aim of this study is to investigate the acute and short-term alterations in hemodynamic conditions using the echocardiography outcomes in patients undergoing TAVI. METHODS AND RESULTS: A total of 60 patients (26 males, 34 females; age 84·7 ± 5·8) who underwent TAVI with CoreValve system were included in the study. Echocardiography was performed before hospital discharge and at 3 months follow-up. As expected, TAVI was associated with an immediate significant improvement in aortic valve area (AVA) (from 0·64 ± 0·16 cm(2) to 1·67 ± 0·41 cm(2) , P-value<0·001) and mean gradient (from 51·9 ± 15·4 mmHg to 8·8 ± 3·8 mmHg, P-value<0·001). At 3-month follow-up, systolic LV function was augmented (EF: 50 ± 14% to 54 ± 11%, P-value = 0·024). Left ventricle (LV) mass and left atrium (LA) volume were significantly reduced (LV mass index from 126·5 ± 30·5 g m(-2) to 102·4 ± 32·4 g m(-2) ; LA index from 42·9 ± 17·3 ml m(-2) to 33·6 ± 10·6 ml m(-2) ; P-value<0·001 for both). Furthermore, a decrement in systolic pulmonary artery pressure (SPAP) from 47·5 ± 13·5 mmHg to 42·5 ± 11·2 mmHg, P-value = 0·02 was also observed. Despite the high incidence of paravalvular regurgitation (PVR) (80%), most of the patients presented mild or trace PVR and no significant progress of the regurgitation grade was seen after 3 months. CONCLUSION: This study demonstrates that the beneficial effects of TAVI in cardiac function and hemodynamics occur already after a short period following aortic valve implantation.
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Silva et al. (2014) conducted an observational in aortic stenosis (n=60). Transcatheter aortic valve implantation (TAVI) with CoreValve system vs. Baseline (pre-procedure) was evaluated on aortic valve area (AVA) (p=<0.001). TAVI with the CoreValve system improved aortic valve area and mean gradient immediately post-procedure.
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