THE SHORT-TERM EFFECTS OF TRANSCATHETER AORTIC VALVE IMPLANTATION ON ARTERIAL FUNCTION

Abstract

Objective: Aortic stiffness and hemodynamics are independent predictors of cardiovascular morbidity. Transcatheter aortic valve implantation (TAVI) is growingly used in high-surgical risk patients with aortic stenosis. We sought to investigate the effect of TAVI upon aortic vascular function and hemodynamics. Design and method: We enrolled 67 patients (mean age 80.5 ± 8.1 years, 31 male) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was estimated through carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV). Pulse wave analysis of the radial waveform was also performed for the estimation of aortic augmentation index corrected for heart rate ([email protected]). Measurements were conducted prior to the procedure and at discharge. Results: Before the implantation, mean transvalvular gradient was 50.1 ± 12.9 mmHg for the overall population. 24% presented with LVEF < 50% and 4 patients with low flow- low gradient severe AS. After the implantation, there was a statistically significant increase in arterial stiffness indices (7.7 ± 1.5 vs 8.3 ± 1.9 m/s for cfPWV and 1871 ± 535 vs. 2449 ± 646 cm/s for baPWV, with p < 0.001 for both variables), with a concomitant decrease in wave reflections as assessed by [email protected] (35 ± 12.1% vs 28.7 ± 8.4%, p < 0.001). Post-procedurally, there was also a statistically significant increase in peripheral pulse pressure (72.5 ± 19.4 vs 78 ± 15.8 mmHg, p < 0.05). Conclusions: Our findings depict an increase in arterial stiffness shortly after TAVI, with an improvement of wave reflections. This finding could indicate a “stiffer response” of the vascular system to the acute hemodynamic changes, or an “unmasking” of true aortic stiffness after the relief of the LV outflow obstruction. These findings further elucidate the short-term hemodynamic consequences of aortic valve repair.