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Cardiac Structural Remodeling and Hemodynamic Patterns Following Transcatheter Aortic Valve Replacement

The PARTNER (Placement of Aortic Transcatheter Valve Trial) has been paving the way since 2011, establishing that transcatheter aortic valve replacement (TAVR) is equally effective as surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS).

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The PARTNER (Placement of Aortic Transcatheter Valve Trial) has been paving the way since 2011, establishing that transcatheter aortic valve replacement (TAVR) is equally effective as surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) who are at high surgical risk. In 2019, the advantages of TAVR were extended to patients with minimal surgical risk, with decreased rates of mortality, stroke, and re-hospitalization after one year than with SAVR. It is envisaged that TAVR will become the therapy of choice for many severe AS patients within the next decade. It has been linked to a decrease in aortic valve gradients, better hemodynamics, and the regression of left ventricular (LV) hypertrophy, according to echocardiography. In terms of valve performance, heart function, and long-term follow-up, echocardiography is the preferred imaging modality. As a result, a retrospective observational research study was conducted at a single institution to look at cardiac re-modeling and valve flow patterns 30 days to one year after TAVR.

 
Electronic medical records and echocardiographic data of individuals who had undergone TAVR were analyzed in a retrospective observational research. Because the study was classified as secondary research involving solely medical records review, no patient permission was required. All patient and echocardiographic information were anonymized. The study's main goal was to see if there was a drop in LV mass index after TAVR, in addition to the predicted increase in the aortic valve area and decrease in aortic velocities and gradients. The examination of all other cardiac re-modeling and valvular flow patterns over time were secondary outcomes.


The electronic medical records were used to collect data on patient characteristics at the time of TAVR. Age, sex, social background, medical comorbidities, functional status, and the kind of aortic valve placed were all part of the information. The echocardiography data was taken from the image and numeric data that was made accessible online. The STS score is used to determine a patient's risk of cardiac surgery-related mortality and morbidity. Box and Q-Q plot analysis were used to check for normal distribution, and the Inter Quartile Range technique was used to exclude extreme outliers.


The aortic valve velocities and gradients were shown to be reduced in a predictable manner. In addition, Doppler velocity indices are projected to increase when the prosthesis is implanted. On follow-up echocardiograms, there were no statistically significant changes or trends for aortic insufficiency, other valvular flow patterns, right ventricular function, or ejection fraction. As expected, TAVR causes a decrease in trans-aortic pressure gradients and an increase in the aortic valve area.
LV pressure overload, LV hypertrophic re-modeling, and a rise in relative wall thickness are all symptoms of aortic stenosis. Following TAVR, hemodynamic improvements are predicted following stenosis correction, as well as immediate improvements in LV systolic function and progressive reductions in LV mass and relative wall thickness. Furthermore, post-TAVR KCCQ scores revealed a clinically significant increase in the quality of life of heart failure patients. Understanding more about TAVR's related echocardiographic re-modeling patterns and long-term results is crucial as it will become the treatment of choice for the majority of severe aortic stenosis patients in the future years.

Read more:
Feghaly J, Das D, Oman Z, et al. (November 03, 2021) Cardiac Structural Remodeling and Hemodynamic Patterns Following Transcatheter Aortic Valve Replacement. Cureus 13(11): e19224. doi:10.7759/cureus.19224
 

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