Abstract
Background: the long-term variations of fractional flow reserve derived from coronary computed tomography (FFR CT ) after surgical (SAVR) or transcatheter (TAVR) aortic valve replacement in patients with severe aortic valve stenosis (AS) have not been investigated. Methods and Results: a total of 25 patients with isolated, severe AS underwent coronary computed tomography with 3-vessel FFR CT analysis (Heartflow Inc. - Redwood City, California, USA) and measurement of total coronary volume (V), left ventricular mass (M) and their ratio (V/M) before and 6 months after SAVR or TAVR. A significant increase in V/M due to a decrease in left ventricular mass 6 months after intervention was observed, whereas total coronary volume did not change (coronary volume pre: 2924,5 ± 867,9 mm 3 , coronary volume post: 2844,2 ± 792,8 mm 3 , P =0.158; LV mass pre: 151.7 ± 40.7 g, LV mass post: 127.3 ± 34.7 g, P <0.001; V/M pre: 19.5 ± 4.1 mm 3 /g, V/M post: 22.7 ± 4.28 mm 3 /g, P =0.002). FFR CT (expressed as area under the virtual pullback curve) remained constant. Conclusion: this proof-of-concept study showed that FFR CT was not subject to the confounding effect of left ventricular mass regression after SAVR or TAVR. Despite significant left ventricular remodeling at 6 months after AS treatment, FFR CT values remained constant. This means FFR CT can probably be used as a reliable test in AS patients but further studies are needed comparing the performance of the different invasive and non-invasive coronary physiological indices in this patient cohort.
In which patients is transcatheter aortic valve replacement potentially better indicated than surgery for redo aortic valve disease? Long-term results of a 10-year surgical experience
