Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis (original) (raw)
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2018
Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe symptomatic aortic stenosis (AS) considered inoperable or at high surgical risk. More recently, TAVI has been performed also to lower risk patients based on the Heart Team decision. Few studies have studied interaction between surgical risk categories and outcomes. Aim of the study To analyze safety and efficacy (VARC-2 defined) TAVI treated patients as function of different preoperative risk. To assess independent predictors of death. Methods Four-hundred-eighty-two patients who underwent TAVI in our center between 2007 and 2017 were included in the study. According to Society of Thoracic Surgeons (STS) score and to other parameters, all the patients were retrospectively stratified into 4 groups: prohibitive (contraindications to aortic valve replacement, n = 124), high (STS > 8, n = 131), intermediate (4 ≤ STS ≤ 8, n = 112) and low (STS < 4, n = 115) risk. Early, 1-year ...
European heart journal cardiovascular Imaging, 2014
Transcatheter aortic valve implantation (TAVI) has been shown to improve prognosis of high-risk patients. Data, however, concerning the impact of TAVI on regional and global left atrial (LA) and left ventricular (LV) mechanics in varying entities of severe aortic stenosis (AS) are sparse, particularly in patients with paradoxical low-flow (PLF) AS or with reduced LV ejection fraction (LVEF). This study evaluated the effects of TAVI on LA and LV mechanics in varying entities of AS 12 months after implantation. A total of 54 consecutive patients with severe AS (24 with a normal LVEF and normal flow, 16 with PLF, and 14 with a reduced LVEF) were included. Speckle tracking echocardiography was performed before and 12 months after TAVI to determine LV global and regional longitudinal deformation as well as LA function (reservoir function, conduit phase, and active contraction). In all the three entities of AS, there was a significant improvement in global and regional LV longitudinal fun...
Heart, 2012
Objective To investigate early haemodynamic changes after transfemoral transcatheter aortic valve implantation (TAVI) and the relationship with myocardial injury and neurohormonal activation. Design Single-centre prospective observational study. Setting Tertiary cardiac centre. Patients 42 patients undergoing transfemoral TAVI were included in this study. Main outcome measures Haemodynamic measurements and echocardiography-derived indices characterising myocardial function were recorded at baseline, 6 and 24 h postprocedure. Postprocedural myocardial injury was quantified using serum troponin I and CK-MB levels. In addition, biomarkers of myocardial dysfunction/heart failure and neurohormonal activation were measured. Results 6 h Post-TAVI there was a significant deterioration in both systolic and diastolic function as measured by dP/dt max /EDV, myocardial performance index and mean E/e' index. Recovery of myocardial function was observed at 24 h. These haemodynamic changes were associated with a significant increase in both troponin I (0.0760.01 vs 1.5960.21 mg/l, p<0.005) and CK-MB (1.9960.19 vs 6.8260.7 ng/ml, p<0.005). There was a positive correlation among myocardial injury and NT-BNP (r¼0.34, p<0.0005), aldosterone (r¼0.56, p<0.0001) and ST2 levels (r¼0.21, p<0.05). Conclusions This is the first study to demonstrate that procedurally successful TF-TAVI results in a transient depression of both systolic and diastolic left ventricular function within the first 24 postoperative hours, despite impressive relief of previously severe, chronic pressure overload. The rise in the markers of myocardial damage suggests that this may be due to periprocedural myocardial injury. Complete recovery of contractility is generally observed after 24 h.
European Journal of Heart Failure, 2012
Aims This prospective study aimed to evaluate the prognostic impact of left ventricular ejection fraction (LVEF) and aortic mean gradient patterns on outcome after transcatheter aortic valve implantation (TAVI). Methods and results From 2008 to 2011, 202 consecutive patients with severe symptomatic aortic valve stenosis (aortic valve area ,1.0 cm 2) were submitted to TAVI. Patients were divided into four groups according to LVEF (.50% vs. ≤50%) and aortic mean pressure gradient (.40 mmHg vs. ≤40 mmHg): group 1, preserved LVEF/high gradient (n ¼ 86); group 2, preserved LVEF/low gradient (n ¼ 27); group 3, reduced LVEF/high gradient (n ¼ 45); and group 4, reduced LVEF/low gradient (n ¼ 44). A CoreValve prosthesis (Medtronic, Minneapolis, MN, USA) was inserted retrogradely. Echocardiography was performed before and 1 year after TAVI. The primary study endpoint (1-year all-cause mortality) was reached in 47 patients (23%). All-cause mortality was lowest in group 1 (14%), intermediate in group 2 (22%) and group 3 (27%), and highest in group 4 (39%) (P ¼ 0.007). In survivors, aortic mean gradient decreased in all patients (baseline 48 + 13 mmHg vs. 10 + 4 mmHg at 1 year, P , 0.001). LVEF improved in group 3 and group 4 (baseline 42 + 8% vs. 51 + 11% at 1 year, P , 0.001). Conclusion Severe aortic stenosis with low gradient and/or reduced LVEF is associated with worse outcome after TAVI compared with aortic stenosis with preserved LVEF/high gradient. The evaluation of these haemodynamic parameters may help to improve risk stratification in patients undergoing TAVI.
Catheterization and Cardiovascular Interventions, 2014
Objectives: To identify predictors of mortality, functional status, and hemodynamical changes of patients undergoing transcatheter aortic valve implantation (TAVI) for low flow/low gradient aortic stenosis (LF/LG AS). Background: There is little published data regarding the outcomes of patients with LF/LG AS following TAVI. Methods: Sixtyeight patients with severe AS, left ventricular dysfunction (ejection fraction [EF] <35%) and low flow (LF) AS underwent TAVI. Patients were stratified according to the aortic mean pressure gradient (low gradient [LG]; with P mean 40 mm Hg and high gradient [HG]: P mean >40 mm Hg). The baseline parameters and clinical outcomes were subsequently compared among the two groups. Cox proportional hazards were used to identify predictors of 6-month mortality. Results: There were 38 patients in the LG group and 30 patients in the HG group. There were no significant difference in 30-day mortality between the two groups. The 6-month and 1-year mortality, however, was 3.8-fold and 2.8-fold higher in the LG group than in the HG group (37.8% vs. 10.3%, P 5 0.01 and 37.8% vs. 13.3%, respectively, P 5 0.01). Univariable predictors for 6-month mortality were: STS Score, aortic valve area, and aortic mean pressure gradient. However, only STS Score (HR 1.08, 1.04-1.12, P < 0.001) remained as independent predictor in the multivariable analysis. Six months after TAVI, hemodynamical (EF > 50%) and clinical (NYHA class I) improvements were shown in both HG and LG groups. Conclusions: LF/LG AS does not influence procedural mortality after TAVI but exhibits a strong impact on 6-month and 1-year mortality. The survivors, however, exhibit considerable hemodynamical and clinical improvements. Therefore, risk stratification and TAVI benefit should be weighted in every patient with LF/LG AS. V
Internal Medicine
Aortic stenosis is one of the most common valve diseases in patients over 60 years of age. Lack of prompt surgical correction by conventional valve replacement or interventional transcatheter aortic valve implantation (TAVI) increases the risk of morbidity and mortality, in the context of worsening clinical picture. Since the first interventional transcatheter valve implantation procedure in 2012 and to date, the evolution of technology and refinement of medical techniques has led to the refinement of the treatment method and thus to the improvement of the prognosis of patients with aortic stenosis undergoing TAVI after only one month.
Research Square (Research Square), 2021
We sought to assess the prognostic role of the extent of cardiac damage among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Methods A staging classi cation was applied to 262 patients from the EffecTAVI Registry at baseline and reassessed within 30-day after TAVI. All-cause mortality at 1-year was the primary endpoint of the study. Cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis and rehospitalization for all caused were included as secondary endpoints. Results At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-day after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a signi cant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p= 0.08). No differences were found in secondary endpoints. Conclusions Although TAVI might be associated with an amelioration of the left ventricular diastolic and right ventricular function, patients with a greater extent of cardiac damage at baseline are at higher risk of mortality at 1-year after the procedure.