Hemodynamic outcomes of transcatheter aortic valve implantation with the CoreValve system: an early assessment.

Abstract

Transcatheter aortic valve implantation (TAVI) is an established method for the treatment of high-risk patients with aortic stenosis (AS). The beneficial effects of TAVI in cardiac hemodynamics have been described in recent studies, but those investigations were mostly performed after an interval of more than 6months following aortic valve implantation. The aim of this study is to investigate the acute and short-term alterations in hemodynamic conditions using the echocardiography outcomes in patients undergoing TAVI. A total of 60 patients (26 males, 34 females; age 84·7±5·8) who underwent TAVI with CoreValve system were included in the study. Echocardiography was performed before hospital discharge and at 3months follow-up. As expected, TAVI was associated with an immediate significant improvement in aortic valve area (AVA) (from 0·64±0·16cm(2) to 1·67±0·41cm(2) , P-value<0·001) and mean gradient (from 51·9±15·4mmHg to 8·8±3·8mmHg, P-value<0·001). At 3-month follow-up, systolic LV function was augmented (EF: 50±14% to 54±11%, P-value=0·024). Left ventricle (LV) mass and left atrium (LA) volume were significantly reduced (LV mass index from 126·5±30·5gm(-2) to 102·4±32·4gm(-2) ; LA index from 42·9±17·3mlm(-2) to 33·6±10·6mlm(-2) ; P-value<0·001 for both). Furthermore, a decrement in systolic pulmonary artery pressure (SPAP) from 47·5±13·5mmHg to 42·5±11·2mmHg, P-value=0·02 was also observed. Despite the high incidence of paravalvular regurgitation (PVR) (80%), most of the patients presented mild or trace PVR and no significant progress of the regurgitation grade was seen after 3months. This study demonstrates that the beneficial effects of TAVI in cardiac function and hemodynamics occur already after a short period following aortic valve implantation.