ACUTE EFFECTS OF SURGICAL AORTIC VALVE REPLACEMENT ON AORTIC HEMODYNAMICS AND WAVE REFLECTIONS

Abstract

Objective: Aortic hemodynamics and wave reflections are independent predictors of adverse cardiovascular events. Surgical aortic valve replacement (SAVR) is still the first choice for treatment of patients with aortic stenosis. We sought to investigate in this pilot study the effect of SAVR upon aortic vascular function and hemodynamics. Design and method: Twenty-five patients (mean age 71.0 ± 7.1 years, 11 female) with severe aortic stenosis undergoing SAVR were included. Aortic hemodynamics and wave reflections (aortic pressures, aortic augmentation index [[email protected]], augmented pressure) and subendocardial viability ratio (SEVR) were measured with Sphygmocor. Measurements were conducted prior to the surgery and at discharge. Results: There was a statistically significant decrease in aortic systolic blood pressure (SBP) (134 ± 24 vs 118 ± 17mmHg with p = 0.002, respectively). that was not apparent in peripheral SBP. Diastolic blood pressure (both peripheral and aortic) did not change significantly, while heart rate was increased after the surgery (67 ± 11 vs 88 ± 15 bpm with p < 0.001, respectively). We observed a marginally significant decrease in aortic [email protected] (29 ± 13 vs 22 ± 12% with p = 0.05, respectively) and a decrease in aortic AIx (p < 0.001, Figure) and augmented pressure (20 ± 10 vs 8 ± 7 mmHg with p < 0.001, respectively). Moreover, there was a marginally non-significant trend for an increase in SEVR (137 ± 30 vs 149 ± 35%, p = 0.095). Conclusions: Our study shows that shortly after SAVR subjects show a decrease in aortic wave reflections with a small improvement of myocardial perfusion. These findings further elucidate the short-term hemodynamic consequences of SAVR.