Abstract
Objectives and Background: To investigate short-term hemodynamic improvement following transcatheter aortic valve implantation (TAVI) in patients with severe aortic valve stenosis (AS) using the non-invasive NICaS® whole body electrical bio-impedance monitoring system. Methods: 52 unselected patients subjected to TAVI were analysed between January and September 2018. Endovascular TAVI was applied in local anaesthesia and analgosedation in all patients using the Medtronic Evolut R® (n=32), Edwards Sapien 3® (n=14) or Boston Scientific SYMETIS ACURATE neo ™ TF® (n=4) system. NICaS® measurements were performed at baseline, six to eight hours after TAVI procedure and before discharge. Results and Discussion: When comparing discharge to baseline, there was a successful increase in cardiac output (CO) from 5.01 ± 1.62 to 5.73 ± 1.41 L/min (P=0.009) corresponding to a cardiac index (CI) increase from 2.64 ± 0.80 to 3.13 ± 0.83 L/min/m2 (P=0.002) and of increase in cardiac power index (CPI) from 0.53 ± 0.18 to 0.61 ± 0.16 w/m2 (P=0.008). Additionally, total peripheral resistance (TPR) significantly decrease from 1597.58 ± 624.92 to 1291.29 ± 450.12 dynes*s/cm5 (P=0.0045) corresponding to a total peripheral resistance index (TPRI) decrease from 2968.88 ± 1078.78 to 2436.72 ± 902.37 dynes*s/cm5/m2 (P=0.006). Conclusion: Non-invasive hemodynamic measurements with NICaS® represent an accurate bedside-tool for monitoring short-term adaptive hemodynamic changes in unselected patients subjected to TAVI. Thus, results can be easily used for tailored peri-procedural management early patients´ mobilization and discharge planning.
Highlights
Aortic Valve Stenosis (AS) as one of the most frequent acquired valvular heart disease represents a major health problem with an appalling annual death in the growing population of elderly patients [1]
Beneficial short and long term outcome is proven for transfemoral transcatheter aortic valve implantation (TAVI) throughout the whole specter of transcatheter valve deploying systems, little is known about immediate and post-procedural short term hemodynamic changes compared to patientsbaseline status
Patients scheduled to TAVI procedure Subjects (n) Male/female Age Body mass index Functional NYHA Class NYHA Class I NYHA Class II NYHA Class III NYHA Class IV Angina Syncope Echocardiographic values
Summary
Aortic Valve Stenosis (AS) as one of the most frequent acquired valvular heart disease represents a major health problem with an appalling annual death in the growing population of elderly patients [1]. Beneficial short and long term outcome is proven for transfemoral TAVI throughout the whole specter of transcatheter valve deploying systems, little is known about immediate and post-procedural short term hemodynamic changes compared to patientsbaseline status. This depends on the need of additional- predominantly invasive-hemodynamic measurement tools such as Swan-Ganz® or PICCO® catheterisation systems. Most of these data is missing or available only from baseline right heart catheterization [3]. These parameters may offer an accurate tool for tailored peri and post procedural in-hospital management and for discharge planning
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