Abstract 16029: Patient Prosthesis Mismatch Post Transcatheter Aortic Valve Replacement is Associated With Lack of Improved Left Ventricular Diastolic Function

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ashvita Ramesh ◽  
Andrew C Peters ◽  
Fei Fei Gong ◽  
Madeline Jankowski ◽  
Eric Cantey ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Diastolic Function ◽  
Valve Replacement ◽  
Cardiac Remodeling ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Transcatheter Aortic Valve ◽  
Patient Prosthesis Mismatch

Background: Patient prosthesis mismatch (PPM) is a frequent problem after transcatheter aortic valve replacement (TAVR) that results in adverse cardiac remodeling. This study sought to evaluate the association between PPM and changes in diastolic function post-TAVR. Methods: 339 patients (79.3+8.8 y, 44.4% female) who underwent TAVR for severe aortic stenosis between 2015-2018 with an echocardiogram (echo) at baseline and at 1-year were studied. Echo measurements were performed according to ASE guidelines. Moderate PPM is defined by an indexed effective orifice area (iEOA) of <0.85 to >0.65 cm 2 /m 2 , and severe PPM by an iEOA <0.65 cm 2 /m 2 . The aortic valve acceleration to ejection time ratio (AT/ET) was measured to further stratify patients with PPM and considered abnormal if >0.35. Student’s t-tests were used to compare diastolic function at baseline and 1-year. Results: We found that 26.2% of subjects had moderate PPM, 11.8% had severe PPM, and 8.3% had an AT/ET >0.35 (Table 1). Tissue velocity at both the medial and lateral mitral annulus was reduced at baseline and did not improve. Left atrial pressure (LAP) as assessed by E/e` improved in those without PPM (19.5+9.5 to 18.8+9.6, p=0.04) and those with moderate PPM (21+12.2 to 18.2+6.9, p=0.03), but not in those with severe PPM or with AT/ET>0.35. Right ventricular systolic pressure (RVSP) decreased significantly in patients with no or moderate PPM (39.6+13.6 mmHg to 35.5+10.8 mmHg, p=0.02 and 41.2+13.9 mmHg to 36+10.8 mmHg, p=0.006; respectively), while there was no significant decrease for patients with severe PPM or with AT/ET>0.35. Conclusion: We found that in patients undergoing TAVR, diastolic function was impaired as evidenced by low mitral tissue velocities, elevated LAP, and elevated RVSP. PPM resulted in less improvement of diastolic parameters including no improvement in LAP and RVSP. These findings suggest that severe PPM has an adverse effect on cardiac remodeling.

scholarly journals The discongruence index, a simple predictor of cardiac remodeling after transcatheter aortic valve replacement

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Islas ◽  
A De Agustin ◽  
P Jimenez ◽  
L Nombela ◽  
P Marcos Alberca ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cardiac Remodeling ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Transcatheter Aortic Valve

Abstract Background Aortic stenosis causes several changes in left ventricular (LV) geometry and function; cardiac remodeling after transcatheter aortic valve replacement (TAVR) is variable among patients and it is not clearly defined. The aim of this study is to identify factors associated with LV functional and structural recovery. Methods 428 patients were retrospectively studied; all patients underwent transthoracic echocardiography prior to TAVR; specific measurements such as maximum internal diameter of the prosthetic valve, nominal loss and percentage of nominal loss regarding to valve size, as well as the discongruence index (Prosthesis size/BSA) were evaluated at discharge and 1-year follow up. Positive cardiac remodeling (PCR) was considered if patients had a reduction of ≥20% of left ventricle mass index (LVMi) and ≥10% of end-diastolic volume index (LVEDVi). Results Mean age of the cohort was 83±5.6 years, 55% were female (n=236), mean aortic valve area was 0.7±0.2cm2; mean LVMi and LVEDVi were 129.4±35.4gr/m2 and 54.5±22ml/m2 respectively. LVMi reduction ≥20% was observed in 30% (n=128) of patients; LVEDVi reduction ≥10% was observed in 44% (n=188) of patients. A total of 107 patients (25%) showed PCR. Female patients showed more PCR (p=0.04). Discongruence index was significantly higher in patients with PCR (15.5±1.9 vs 14.5±1.8, p=0.01) and was significantly associated to LVMi (121.5±28.9 vs 150.8±41.1g/m2) and LVEDVi individually (55.1±17.2 vs 42.7±16.7ml/m2; p&lt;0.01). Left ventricular ejection fraction (LVEF) had a statistically significant increase among patients with PCR (53.2±14.9 vs 56.7±11.5, p=0.04) global longitudinal strain showed improvement at 1-year follow-up as well, although not statistically significant (−17.3±3.7 vs −18.3±3.4 p=0.53). Conclusions The discongruence index is a simple and feasible parameter that can predict positive cardiac remodeling after TAVR which can have a significant impact in clinical outcome of patients. FUNDunding Acknowledgement Type of funding sources: None.

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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