Citation: Cardiovascular Revascularization Medicine. 19(3 Pt A):257-262, 2018 04..Journal: Cardiovascular revascularization medicine : including molecular interventions.Published: ; 2018ISSN: 1878-0938.Full author list: Kiramijyan S; Koifman E; Magalhaes MA; Ben-Dor I; Didier R; Jerusalem ZD; Kumar S; Tavil-Shatelyan A; Rogers T; Steinvil A; Gai J; Torguson R; Satler LF; Pichard AD; Waksman R.UI/PMID: 29174824.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: https://dx.doi.org/10.1016/j.carrev.2017.09.011 (Click here)Abbreviated citation: Cardiovasc Revasc Med. 19(3 Pt A):257-262, 2018 04.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: OBJECTIVE: Evaluation of invasive hemodynamic parameters as prognostic markers of mortality in patients undergoing TAVR.Abstract: BACKGROUND: The value of invasive intraprocedural hemodynamic evaluation of patients undergoing transcatheter aortic valve replacement is unclear.Abstract: 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.Abstract: 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:  pre<1.9, stable_post<1.9;  pre<1.9, improved_post>=1.9;  pre>=1.9, stable_post>=1.9; and  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).Abstract: CONCLUSIONS: In patients with severe aortic stenosis undergoing TAVR, invasive monitoring can assess for hemodynamic prognostic markers of survival.Abstract: Copyright (c) 2017 Elsevier Inc. All rights reserved.