scholarly journals Computed tomography angiography-derived extracellular volume fraction predicts early recovery of left ventricular systolic function after transcatheter aortic valve replacement

2020 ◽  
Author(s):  
Donghee Han ◽  
Balaji Tamarappoo ◽  
Eyal Klein ◽  
Jeffrey Tyler ◽  
Tarun Chakravarty ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Volume Fraction ◽  
Systolic Function ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction ◽  
Left Ventricular ◽  
Absolute Increase ◽  
Transcatheter Aortic Valve

Abstract Aims  Recovery of left ventricular ejection fraction (LVEF) after aortic valve replacement has prognostic importance in patients with aortic stenosis (AS). The mechanism by which myocardial fibrosis impacts LVEF recovery in AS is not well characterized. We sought to evaluate the predictive value of extracellular volume fraction (ECV) quantified by cardiac CT angiography (CTA) for LVEF recovery in patients with AS after transcatheter aortic valve replacement (TAVR). Methods and results  In 109 pre-TAVR patients with LVEF <50% at baseline echocardiography, CTA-derived ECV was calculated as the ratio of change in CT attenuation of the myocardium and the left ventricular (LV) blood pool before and after contrast administration. Early LVEF recovery was defined as an absolute increase of ≥10% in LVEF measured by post-TAVR follow-up echocardiography within 6 months of the procedure. Early LVEF recovery was observed in 39 (36%) patients. The absolute increase in LVEF was 17.6 ± 8.8% in the LVEF recovery group and 0.9 ± 5.9% in the no LVEF recovery group (P < 0.001). ECV was significantly lower in patients with LVEF recovery compared with those without LVEF recovery (29.4 ± 6.1% vs. 33.2 ± 7.7%, respectively, P = 0.009). In multivariable analysis, mean pressure gradient across the aortic valve [odds ratio (OR): 1.07, 95% confidence interval (CI): 1.03–1.11, P: 0.001], LV end-diastolic volume (OR: 0.99, 95% CI: 0.98–0.99, P: 0.035), and ECV (OR: 0.92, 95% CI: 0.86–0.99, P: 0.018) were independent predictors of early LVEF recovery. Conclusion  Increased myocardial ECV on CTA is associated with impaired LVEF recovery post-TAVR in severe AS patients with impaired LV systolic function.

Abstract 16138: Validation of a Non-invasive Approach for the Assessment of Left Ventricular-arterial Coupling Following Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emad Mogadam ◽  
David Shavelle ◽  
Jing Liu ◽  
Gregory Giesler ◽  
Ray Matthews ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Systolic Function ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Arterial Elastance ◽  
Invasive Approach ◽  
Transcatheter Aortic Valve

Introduction: Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe, symptomatic aortic stenosis (AS). Ventriculoarterial (LV-arterial) coupling defined as the ratio of total arterial elastance (Ea) to left ventricular end-systolic elastance (Ees) reflects effective cardiac energetics and is a well-accepted index for quantification of LV-arterial coupling. Despite its usefulness, estimating Ees/Ea has technical difficulties. Intrinsic Frequency (IF) method is a noninvasive and single waveform system-based approach for quantification of LV-arterial coupling. The objective of this study was to compare IF variables with Ea/Ees in predicting optimum LV-arterial energetics following TAVR. Method: Twenty-eight patients with severe AS, undergoing TAVR were included. Mean age was 85±4, 53% male with mean ejection fraction 59±6.4. IFs during systole (ω1), diastole (ω2), and total IF variation (Δω=ω1-ω2) were computed from the ascending aortic pressure waveforms at baseline and following TAVR. Ea/Ees was computed using single-beat technique proposed by Takeuchi et al. ( Circulation . 1991;83(1):202-212). Results: There was a significant decrease in Ea/Ees (p<0.001) toward optimum coupling immediately after TAVR (Figure 1a). There was a statistically significant correlation between Ea/Ees and Δω (r= 0.68, p<0.01) (Figure 1b). Conclusion: IF appears to be an accurate and reliable index for quantification of LV-arterial coupling given significant concordance with Ea/Ees. The management of patients with acutely altered hemodynamic states post TAVR can benefit from the assessment of LV-arterial coupling. Since IFs can be measured noninvasively using hand-held devices (e.g. an iPhone), this approach should broaden the clinical applicability of this useful parameter for assessing systolic function, therapeutic response and ventricular-arterial interaction post TAVR.

scholarly journals More in, better out? Successful valve-in-valve procedure of an iatrogenic ventricular septal defect following transcatheter aortic valve replacement: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Klaus-Dieter Hönemann ◽  
Steffen Hofmann ◽  
Frank Ritter ◽  
Gerold Mönnig
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Septal Defect ◽  
Left Ventricular ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve

Abstract Background A rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD). Case summary We describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2–3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Discussion We suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.

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