Introduction:
Transcatheter aortic valve implantation (TAVI) is a procedure that alters dramatically the hemodynamics in patients with severe aortic valve stenosis who undergo this procedure.
Hypothesis:
We investigated the hypothesis that arterial properties and hemodynamics are affected immediately after TAVI as well as in the long-term.
Methods:
We enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV) were used for the assessment of arterial stiffness. Augmentation index corrected for heart rate (AIx@75) and subendocardial viability ratio (SEVR) were measured non-invasively. Measurements were conducted at baseline, after the procedure (during hospitalization) and at 1 year.
Results:
Acutely after TAVI we observed a statistically significant increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.9 m/s, p=0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,383 ± 645 cm/s, p<0.001 for baPWV) without a concomitant change in systolic blood pressure (Figure). One year later, arterial stiffness was still increased compared to pre-TAVI measurements (7.5 ± 1.5 m/s vs 8.7 ± 1.7 m/s, p<0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,286 ± 575 cm/s, p<0.001 for baPWV). We also found a decrease in AIx@75 (32.2 ± 12.9 % vs 27.9± 8.4 %, p=0.016) after TAVI that was attenuated at 1-year follow-up (32.2 ± 12.9 % vs 29.8± 9.1 %, p=0.38). SEVR displayed an increase acutely after TAVI (131.2 ± 30.0 % vs 148.4± 36.1 %, p=0.002) and remained improved 1 year after the procedure (131.2 ± 30.0 % vs 146± 32.2 %, p=0.01).
Conclusions:
In conclusion, shortly after TAVI the aorta exhibits a "stiffer" behavior in response to the acute change in hemodynamics, which settles in the long term. Our findings further elucidate the hemodynamic consequences of TAVI and may entail a prognostic role in this growing population.
Vascular complications after transcatheter aortic valve implantation (TAVI): risk and long-term results