P432Evaluation of the normal doppler hemodynamics of edwards sapien and corevalve transcatheter aortic valves


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Abstract

Purpose: Transcatheter aortic valve implantation (TAVI) is a new therapeutic option for high-risk patients with severe aortic stenosis. As the survival is higher as opposed to best medical care the need for further follow up evaluation of this new class of bioprothestic valve is evident and therefore the normal Doppler hemodynamics have to be established.Methods: We retrospectively analysed comprehensive Doppler echocardiographic examinations of 90 patients after successful TAVI who were clinically stable to establish the normal hemodynamics of various types and sizes of these distinctive bioprosthetic valves. The earliest complete postoperative transthoracic echocardiogram but at least 6 days postoperative was identified for each patient. Doppler examinations were analysed for peak instantaneous velocity, and peak and mean systolic gradient, and, if possible, the effective orifice area (EOA) and the indexed EOA was determined by the continuity equation. Patients with more than moderate paravalvular aortic regurgitation or more than moderate mitral valve regurgitation were excluded.Results: The overall peak instantaneous velocity (n= 90; mean LVEF 60±11%) was 1.9±0.4 m/s, with a peak systolic gradient of 15.0±7.3 mm Hg and a mean systolic gradient of 8.0±4.2 mm Hg. The mean EOA was 1.8 cm2±0.4 with an indexed EOA of 0.9±0.3 cm2/m2. The values for every aortic valve prosthesis are shown in Table 1.Conclusions: This study establishes the normal range for Doppler hemodynamics of various transcatheter aortic valves. The mean peak velocity and the pressure gradients for each transcatheter aortic valve tend to be lower and the EOA tends to be larger compared to previously published data of stented surgically implanted bioprosthetic aortic valves. However, a direct comparison is limited since our study includes no control group of matched patients with conventional surgical avalve replacement.

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