Author + information
- Simon Biner,
- Yan Topilsky,
- Yoav Michowitz,
- Shmuel Banai,
- Gad Keren,
- Arie Steinvil,
- Eran Leshem-Rubinow and
- Ariel Finkelstein
Transcatheter aortic valve implantation (TAVI) is characterized by reduction in left ventricular afterload. The study evaluated mid-term structural and functional adaptive response mediated by TAVI.
A total of 250 consecutive patients with severe AS who underwent TAVI by transfemoral approach were retrospectively analyzed. Comprehensive echocardiography was performed at baseline and at 6 month. Left ventricular end systolic (LVESV) and end diastolic (LVEDV) volumes were measured by Simpson's rule. Right ventricular (RV) performance was assessed by RV end diastolic and end systolic area and fractional area change (FAC). Left atrial volume was determined by area length method. Aortic regurgitation, mitral regurgitation and tricuspid regurgitation were semi quantitatively graded from 0 to 4.
Medtronic CoreValve prosthesis was used in 86% of patients, Edwards Sapien was used in remaining of cases. Permanent pacemaker was implanted in 23% of patients. At 6 month follow up there was an increase in LVEDV (97 ± 26 ml vs. 102 ±31ml, P = 0.001), LVEF (57 ± 11% vs. 59 ± 10%, P = 0.034), Left ventricular stroke volume (54.7 ±14 ml vs. 59.3 ±16 ml, P < 0.01), as well as an increase in RV end diastolic area (16.1 ± 4.3 cm2 vs. 17. 3 ± 8.8 cm2 P = 0.049) and RV FAC (0.43 ± 0.9 vs. 0.46 ± 0.1, P = 0.003). Systolic pulmonary artery pressure (43.6 ± 14.5mmHg vs. 40.6 ± 13.7mmHg, P = 0.031) and left atrial volume (97 ± 35 ml vs. 86 ± 29; P = 0.018) decreased. No change was observed in LVESV and RV end systolic area. There was and no change in overall aortic regurgitation, mitral regurgitation, and tricuspid regurgitation grade (all p values > 0.3) despite substantial individual pre and post procedural variation.
Structural and function adaptation at 6 month after TAVI is characterized by increase in LVEDV, RV end diastolic area and enhanced left ventricular and RV ejection indices. It is also associated with reduction of systolic pulmonary artery pressure and left atrial volume. The procedure may be associated with sizable change in valvular regurgitation grade in individual patients; however, the magnitude of this change appears to be insignificant for entire cohort.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Imaging: Echo – Aortic Valve Diseases
Abstract Category: 18. Imaging: Echo
Presentation Number: 1144-369
- 2013 American College of Cardiology Foundation