Abstract 18424: Changes in Cardiac Hemodynamics and Geometry After Transcatheter Aortic Valve Replacement

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Abstract

Introduction: The introduction of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with severe aortic stenosis (AS). However, despite the great initial success of TAVR, little is known about the cardiac hemodynamics and geometrical change post-TAVR

Hypothesis: To investigate the changes in cardiac hemodynamics and geometry following TAVR

Methods: We restricted our analysis to AS patients who had a transthoracic echocardiogram (TTE) at least 6 months prior to index TAVR and follow-up echo 9-18 months later, performed at Duke University Medical Center from 2010 to 2014. Traditional and nontraditional TTE measurements were completed in all pre- and post- TAVR patients, in accordance with American Society of Echocardiography (ASE) recommendations. TTE measures pre- and post-TAVR were compared using Wilcoxon signed rank tests

Results: A total of 152 TAVR patients with a median age of 81 years [74-86]) were included. Median (IQR) EuroSCORE was 14.9 (8.5, 26.4).116 (76%) patients had self-expanding, and 36 (23.7%) had balloon expandable valves. The table shows the baseline echocardiographic measurements and the change in echocardiographic measurements 1 year after TAVR. TAVR resulted in the reduction of left ventricular (LV) mass index (LVMI) (g/m2), median (IQR) 130.1 (115.4-156.5) vs 105.8 (84.9-135.1) P<0.001); LV end diastolic volume (ml) 127 (105-143) vs 120 (100-143) ml, P=0.013); and LV end systolic volume(ml) 55 (38-77) vs 45 (40-65) ml, P=0.027). TAVR also significantly improved LV global longitudinal strain (GLS) and right ventricular GLS -14.4 (-11.3- -15.5) vs -14.8 (-12.2- -16.6) %, and -15.7 (-13.2- -16.9) vs -15.8 (-14.0- -17.0) %, both P<0.001, respectively) without significant change in ejection fraction

Conclusions: In AS patients, TAVR results in significant cardiac hemodynamic and geometrical changes at 1 year post-procedure. TAVR also significantly improved both LV and RV function assessed by GLS.

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