Intraprocedural invasive hemodynamic parameters as predictors of short- and long-term outcomes in patients undergoing transcatheter aortic valve replacement.

MedStar author(s):
Citation: Cardiovascular Revascularization Medicine. 19(3 Pt A):257-262, 2018 04.PMID: 29174824Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Aortic Valve/su [Surgery] | *Catheterization, Swan-Ganz | *Heart Valve Prosthesis | *Hemodynamics | *Monitoring, Intraoperative/mt [Methods] | *Transcatheter Aortic Valve Replacement/is [Instrumentation] | Aged | Aged, 80 and over | Aortic Valve Stenosis/di [Diagnosis] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | Female | Humans | Male | Prosthesis Design | Recovery of Function | Retrospective Studies | Risk Factors | Severity of Illness Index | Time Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment OutcomeYear: 2018Local holdings: Available in print through MWHC library: 2002 - presentISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: BACKGROUND: The value of invasive intraprocedural hemodynamic evaluation of patients undergoing transcatheter aortic valve replacement is unclear.CONCLUSIONS: In patients with severe aortic stenosis undergoing TAVR, invasive monitoring can assess for hemodynamic prognostic markers of survival.Copyright (c) 2017 Elsevier Inc. All rights reserved.METHODS: Consecutive patients who underwent transfemoral TAVR and had complete prospectively collected intraprocedural invasive hemodynamic parameters were retrospectively analyzed. Patients with alternative access, planned general anesthesia, or baseline >=moderate Tricuspid Regurgitation were excluded. Pre- and post-valve implant parameters included heart rate, systolic and diastolic blood pressures, cardiac output and index, pulmonary arterial systolic and diastolic pressures, transaortic pressure gradient and right atrial pressure. The primary end points were the association of the intraprocedural hemodynamic changes with all-cause mortality at 30days and 1year. Extensive Receiver Operating Characteristic analyses yielded dichotomized threshold of hemodynamic values in association with the binary outcome of mortality.OBJECTIVE: Evaluation of invasive hemodynamic parameters as prognostic markers of mortality in patients undergoing TAVR.RESULTS: A total of 312 patients (52% male, mean age 83years) were evaluated. A significant association with 30-day and 1-year mortality was found between intraprocedural post-valve implant cardiac index <1.9 vs. >=1.9L/min/m<sup>2</sup> (Log-ranked p=0.0286 and p=0.0432, respectively). Four subgroups with pre- and post-valve implant CI changes (L/min/m<sup>2</sup>) were compared: [1] pre<1.9, stable_post<1.9; [2] pre<1.9, improved_post>=1.9; [3] pre>=1.9, stable_post>=1.9; and [4] pre>=1.9, worsened_post<1.9. Group 1 (lower CI with no post-valve improvement) had the worst survival, and Group 3 (higher CI and stable post-valve) had the best survival at 1-year follow-up (Log-ranked p=0.0089).All authors: Ben-Dor I, Didier R, Gai J, Jerusalem ZD, Kiramijyan S, Koifman E, Kumar S, Magalhaes MA, Pichard AD, Rogers T, Satler LF, Steinvil A, Tavil-Shatelyan A, Torguson R, Waksman RFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-12-12
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29174824 Available 29174824

Available in print through MWHC library: 2002 - present

BACKGROUND: The value of invasive intraprocedural hemodynamic evaluation of patients undergoing transcatheter aortic valve replacement is unclear.

CONCLUSIONS: In patients with severe aortic stenosis undergoing TAVR, invasive monitoring can assess for hemodynamic prognostic markers of survival.

Copyright (c) 2017 Elsevier Inc. All rights reserved.

METHODS: Consecutive patients who underwent transfemoral TAVR and had complete prospectively collected intraprocedural invasive hemodynamic parameters were retrospectively analyzed. Patients with alternative access, planned general anesthesia, or baseline >=moderate Tricuspid Regurgitation were excluded. Pre- and post-valve implant parameters included heart rate, systolic and diastolic blood pressures, cardiac output and index, pulmonary arterial systolic and diastolic pressures, transaortic pressure gradient and right atrial pressure. The primary end points were the association of the intraprocedural hemodynamic changes with all-cause mortality at 30days and 1year. Extensive Receiver Operating Characteristic analyses yielded dichotomized threshold of hemodynamic values in association with the binary outcome of mortality.

OBJECTIVE: Evaluation of invasive hemodynamic parameters as prognostic markers of mortality in patients undergoing TAVR.

RESULTS: A total of 312 patients (52% male, mean age 83years) were evaluated. A significant association with 30-day and 1-year mortality was found between intraprocedural post-valve implant cardiac index <1.9 vs. >=1.9L/min/m<sup>2</sup> (Log-ranked p=0.0286 and p=0.0432, respectively). Four subgroups with pre- and post-valve implant CI changes (L/min/m<sup>2</sup>) were compared: [1] pre<1.9, stable_post<1.9; [2] pre<1.9, improved_post>=1.9; [3] pre>=1.9, stable_post>=1.9; and [4] pre>=1.9, worsened_post<1.9. Group 1 (lower CI with no post-valve improvement) had the worst survival, and Group 3 (higher CI and stable post-valve) had the best survival at 1-year follow-up (Log-ranked p=0.0089).

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