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Pykäri J, Vasankari T, Ylitalo A, Porela P, Paana T, Malmberg M, Laurila S, Koskinen J, Koivisto T, Savontaus M. Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR. Cardiol Ther 2023; 12:361-369. [PMID: 36899283 DOI: 10.1007/s40119-023-00307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION During the transcatheter aortic valve replacement (TAVR) procedure, hemodynamic measurements can be used to evaluate transcatheter heart valve (THV) performance. We hypothesized that the occurrence of a significant decrease in invasive aortic pressure immediately after annular contact by a self-expanding THV indicates effective annular sealing. This phenomenon could thus be used as a marker for the occurrence of paravalvular leak (PVL). METHODS Thirty-eight patients undergoing TAVR procedure with a self-expandable Evolut R or Evolut Pro (Medtronic) valve prosthesis were included in the study. Drop in aortic pressure during valve expansion was defined as a decrease in systolic pressure of 30 mmHg immediately after annular contact. The primary endpoint was the occurrence of more than mild PVL immediately after valve implantation. RESULTS A pressure drop was seen in 60.5% (23/38) of patients. More than mild PVL requiring balloon post-dilatation (BPD) was significantly more frequent in patients who did not have a systolic pressure decrease > 30 mmHg during valve implantation (46.7% [7/15] vs. 13.0% [3/23], respectively; p = 0.03). Patients without a systolic pressure decrease > 30 mmHg also had a lower mean cover index on computed tomography analysis (16.2% vs. 13.3%; p = 0.016). The 30-day outcomes were similar between the two groups, and echocardiography at 30 days demonstrated more than none/trace PVL in 21.1% (8/38) of patients, with no difference between the two groups. CONCLUSION A decrease in aortic pressure after annular contact is associated with an increased probability of good hemodynamic outcome after self-expanding TAVR implantation. In addition to other methods, this parameter could be used as an additional marker for optimal valve positioning and hemodynamic outcome during the implantation procedure.
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Affiliation(s)
- Jouni Pykäri
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Tuija Vasankari
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Antti Ylitalo
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Pekka Porela
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Tuomas Paana
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Markus Malmberg
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland
| | - Sanna Laurila
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland.,Satakunta Central Hospital, Sairalantie 3, Pori, Finland
| | - Juho Koskinen
- Department of Future Technologies, University of Turku, 20014, Turku, Finland
| | - Tero Koivisto
- Department of Future Technologies, University of Turku, 20014, Turku, Finland
| | - Mikko Savontaus
- Heart Center Turku, University Hospital-University of Turku, Hämeentie 11, 20521, Turku, Finland.
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Alkhouli M, Eleid MF, Nishimura RA, Rihal CS. The Role of Invasive Hemodynamics in Guiding Contemporary Transcatheter Valvular Interventions. JACC Cardiovasc Interv 2021; 14:2531-2544. [PMID: 34887047 DOI: 10.1016/j.jcin.2021.08.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/02/2021] [Accepted: 08/08/2021] [Indexed: 11/17/2022]
Abstract
Recent advances in transcatheter interventions have refueled the interest in utilizing invasive hemodynamics in the catheterization laboratory. The authors review contemporary invasive techniques used to confirm valve disease and guide transcatheter valve interventions. They also discuss the available data and the remaining questions on the role of invasive hemodynamics in current practice and in the future.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Padala M. Commentary: Quantifying Paravalvular Aortic Regurgitation After Transcatheter Aortic Valve Replacement-Correlative Indices vs Causative Factors. Semin Thorac Cardiovasc Surg 2021; 33:931-932. [PMID: 33610696 DOI: 10.1053/j.semtcvs.2021.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Muralidhar Padala
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Georgia; Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
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Van Wiechen MP, Ooms JF, Hokken TW, De Ronde-Tillmans MJ, Goudzwaard JA, Daemen J, De Jaegere PP, Mattace-Raso FU, Van Mieghem NM. Pathways Towards Lean TAVR. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1765056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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