Key result
Retrograde crossing of mechanical aortic prostheses linked to ~94% higher LVEDP and acute regurgitation.
Why the study?
Left ventricular catheterization through mechanical aortic valve prostheses requires evaluation to assess catheter-induced aortic regurgitation and its hemodynamic effects.
Does retrograde left ventricular catheterization through mechanical aortic prostheses allow safe and accurate hemodynamic assessment in patients with prior aortic valve replacement?
Observational (n=23)
Does retrograde left ventricular catheterization through mechanical aortic prostheses allow safe and accurate hemodynamic assessment in patients with prior aortic valve replacement?
Retrograde left ventricular catheterization through mechanical aortic prostheses is a feasible and safe alternative to transseptal or direct LV puncture, despite inducing transient, quantifiable aortic regurgitation.
Catheter crossing induces ~27% regurgitation with hemodynamic shifts; leaves open whether alternative access improves safety in mechanical aortic prostheses.
Twenty-three patients who had undergone aortic valve replacement with a mechanical aortic vlave prosthesis (ball-valve: 17, tilting-disc: 6) were investigated by retrograde left ventricular catheterization using a 6 F pigtail catheter. Tweleve of these 23 patients also had combined aortic and mitral valve replacement. To assess the magnitude of the catheter-induced aortic regurgitation and its effect on left ventricular and mitral valve function, 10 patients (group 1) were simultaneously investigated by the transseptal route (8 patients) or direct left ventricular puncture. The 13 other patients (group 2) were studied only by the retrograde crossing of the aortic valve prosthesis. In group 1, placement of the catheter across the valve induced an increase in heart rate (+ 12%), in left ventricular end-diastolic pressure (from 17.2±9.6 to 33.3±12.0 mmHg), a decrease om aortic systolic (−19%) and diastolic (−25%) pressures, and left ventricular systolic pressure (−10%). Transvalvular aortic pressure gradient increased from 15.4±8.2 to 23±12.1 mmHg. Pre- and post-crossing pressure gradients were linearly correlated (r=0.98). Hence, the magnitude of catheter-induced aortic regurgitation averaged 27% whether or not a pre-crossing regurgitation was noted. In group 2, retrograde crossing of the aortic valve prosthesis induced similar hemodynamic changes. There were no catheterization-related complications. On the basis of catheterizations studies, re-operation was contraindicated in 2 patients because of severe left ventricular depression, and recommended in 18: aortic valve dysfunction in 14 patients, mitral valve incompetence in 4 patients. In 3 patients, the hemodynamic study ruled out any aortic valve prosthesis dysfunction, associated mitral valve disease and depressed left ventricular function. Intraoperative findings (15 patients) and postmortem examination (7 patients) were consistent with catheterization data. Left ventricular retrograde catheterization is an alternative technique of investigation for patients with mechanical valves in both mitral and aortic positions or in centers where the usual approach (transseptal catheterization or direct LV puncture) are not performed.
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Rigaud et al. (1987) conducted an observational in Mechanical aortic valve prosthesis (n=23). Retrograde left ventricular catheterization vs. Transseptal route or direct left ventricular puncture was evaluated on Hemodynamic changes including left ventricular end-diastolic pressure and catheter-induced aortic regurgitation. Retrograde left ventricular catheterization through mechanical aortic prostheses increased left ventricular end-diastolic pressure from 17.2 to 33.3 mmHg and induced 27% aortic regurgitation.
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