Non-invasive hemodynamic evaluation following TAVI for severe aortic stenosis

To read the full-text of this research, you can request a copy directly from the authors.


Funding Acknowledgements Type of funding sources: None. Background Various hemodynamic changes occur following Transcatheter aortic valve implantation (TAVI) that impact treatment decisions. NICaS, a noninvasive whole-body bio-impedance monitoring system to assess hemodynamics and fluid balance, was tested in patients with severe aortic stenosis (AS) before and after TAVI. Methods Between October 2019 and December 2020 all consecutive patients with severe AS undergoing TAVI were assessed by NICaS at several time points – 24 hours before (baseline) and after the procedure, at hospital discharge and at 30 days to 1 year follow-up. Excluded were patients undergoing TAVI due to reasons other than severe AS, patients under general anesthesia and those who died at the catheterization lab or immediately following the procedure. Results We performed hemodynamic analysis on 97 consecutive patients who underwent TAVI using either Medtronic Evolut R (54%), Edwards Sapien 3 (32%) or SYMETIS ACURATE neo (13%). Patients were more often women (54%) and had multiple comorbidities including hypertension (83%), dyslipidemia (79%), coronary artery disease (46%), and diabetes mellitus (37%). Compared to baseline NICaS measurements, we observed increases in systolic blood pressure (BP) and total peripheral resistance (TPR) within 24 hours following TAVI (systolic BP 132.5±22.3 mmHg at baseline versus 148.4±23.9 mmHg after TAVI, P<0.001; TPR 1754±520 versus 2094±752 dynes*s/cm5, respectively, P<0.001) while cardiac output (CO), cardiac index (CI) and stroke volume (SV) decreased (CO 4.2±1.2 versus 3.9±1.2 L/min, respectively, P=0.013; SV 62±15 versus 56±15.8 mL, P=0.002). However, opposite trends were demonstrated exclusively in patients with ejection fraction (EF) under 40%. At follow-up (median 59 days, IQR [39.5-91]) these hemodynamic measurements returned to values that were not statistically different from the baseline, despite a significant improvement in EF from baseline to follow-up (55.6±11.6 to 59.4±9.4%, P<0.001). Conclusion A unique pattern of short and longer term adaptive hemodynamic changes was demonstrated using the NICaS system among patients undergoing TAVI. These findings require validation and further research to their underlying mechanism if NICaS is to be used as a bedside monitoring tool to guide treatment decisions.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

Full-text available
Background The hemodynamic changes of patients with aortic stenosis (AS) who underwent transcatheter valve replacement (TAVR) have not been completely investigated.Methods and resultsWe enrolled 74 patients with AS who underwent TAVR and assessed cardiac function changes at 1 week post-operation by impedance cardiography (ICG) in a supine position at rest for more than 15 min. Of the 74 patients, 47 had preserved left ventricular ejection fraction (LVEF ≥ 50%; preserved-LVEF group) and 27 had reduced LVEF (LVEF <50%; reduced-LVEF group). TAVR improved the cardiac structure and function, as evidenced by the decrease in the left ventricular end-diastolic (LVED), left atrial diameter (LAD), and an increase in the LVEF. We observed a decrease in N-terminal pro-brain natriuretic peptide (NT-proBNP) level compared to that before treatment. Moreover, patients with reduced LVEF had a more significant reduction of NT-proBNP than those with preserved LVEF. Meanwhile, the blood pressure of patients had no significant differences pre- and post-operation. Based on ICG, there were no changes in the parameter of cardiac preload [thoracic fluid content (TFC)]. We observed an improvement in parameters of diastolic cardiac function [left ventricular ejection time (LVET) and pre-ejection period (PEP)]. And we detected converse results in parameters of heart systolic function [systolic time ratio (STR), cardiac output (CO), cardiac index (CI), stroke index (SI), and stroke volume (SV)] and cardiac afterload [stroke systemic vascular resistance (SSVR) and SSVR-index (SSVRI)]. In addition, TFC level was decreased in patients with thoracic volume overload after valve replacement. Subgroup analysis showed that the changes in those parameters were more noticeable in patients with reduced LVEF than that with preserved LVEF. Moreover, we observed no effects on parameters of heart systolic function and heart afterload in the LVEF ≥ 50% group before and after TAVR.Conclusion Our data revealed a beneficial effect of TAVR in diastolic function and preload as detected by the ICG. But the LV systolic function and cardiac afterload were not improved in patients with LVEF <50%. The result indicated that ICG could be used as an important technique to monitor the cardiac condition of patients after aortic valve replacement.
ResearchGate has not been able to resolve any references for this publication.