Association of a Novel Hemodynamic Index With Aortic Regurgitation After TAVR With the Edwards SAPIEN Valve

Mohananey, Divyanshu; Narayanswami, Jyoti; Kumar, Arnav; Sammour, Yasser; Mick, Stephanie; Navia, Jośe A.; Tuzcu, E. Murat; Krishnaswamy, Amar; Kapadia, Samir

doi:10.1016/j.jcin.2019.03.006

Cited by 7 publications

(4 citation statements)

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“…Although TIARI has a low sensitivity and specificity (0.75 and 0.65, respectively) for predicting the need for BPD, it may have additional value as well as aortographic and echocardiographic evaluation [ 13 ]. Recent studies suggest that hemodynamic markers like the DNI [ 8 ] and the ∆PDAP-LVEDP [ 9 ] could also be used to determine a significant PVL. Limitations in the use of these markers are the need for more time-consuming and advanced calculations, limiting the clinical usefulness of these parameters for intraprocedural assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Aortography and echocardiography are the cornerstones of intraoperative evaluation of PVL [ 6 ]. In addition, several hemodynamic markers, such as Aortic Regurgitant Index (AR index) [ 7 ], Dicrotic Notch Index (DNI) [ 8 ], and the pressure gradient between diastolic aortic pressure and left ventricular end-diastolic pressure (∆PDAP-LVEDP) [ 9 ] have been demonstrated to be useful in evaluating PVL. Limitations in the use of these markers include the need for more advanced calculations, left ventricular catheterization to measure the left ventricular end-diastolic pressure (LVEDP), and confounding factors, such as left ventricular stiffness that raises LVEDP.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR

et al. 2023

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Introduction During the transcatheter aortic valve replacement (TAVR) procedure, hemodynamic measurements can be used to evaluate transcatheter heart valve (THV) performance. We hypothesized that the occurrence of a significant decrease in invasive aortic pressure immediately after annular contact by a self-expanding THV indicates effective annular sealing. This phenomenon could thus be used as a marker for the occurrence of paravalvular leak (PVL). Methods Thirty-eight patients undergoing TAVR procedure with a self-expandable Evolut R or Evolut Pro (Medtronic) valve prosthesis were included in the study. Drop in aortic pressure during valve expansion was defined as a decrease in systolic pressure of 30 mmHg immediately after annular contact. The primary endpoint was the occurrence of more than mild PVL immediately after valve implantation. Results A pressure drop was seen in 60.5% (23/38) of patients. More than mild PVL requiring balloon post-dilatation (BPD) was significantly more frequent in patients who did not have a systolic pressure decrease > 30 mmHg during valve implantation (46.7% [7/15] vs. 13.0% [3/23], respectively; p = 0.03). Patients without a systolic pressure decrease > 30 mmHg also had a lower mean cover index on computed tomography analysis (16.2% vs. 13.3%; p = 0.016). The 30-day outcomes were similar between the two groups, and echocardiography at 30 days demonstrated more than none/trace PVL in 21.1% (8/38) of patients, with no difference between the two groups. Conclusion A decrease in aortic pressure after annular contact is associated with an increased probability of good hemodynamic outcome after self-expanding TAVR implantation. In addition to other methods, this parameter could be used as an additional marker for optimal valve positioning and hemodynamic outcome during the implantation procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR

et al. 2023

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“…A new version of the OptoMonitor software specifically designed for TAVR intervention has been developed. This TAVR-dedicated monitor allows for measurement and display of aortic and left ventricular pressure as well as different metrics derived from them including mean gradient, peak-to-peak gradient, maximum instantaneous gradient, and aortic regurgitation assessment metrics such as aortic regurgitation index 9 and time-integrated regurgitation index. 10 Gradients and regurgitation indices are displayed in live and playback screens as well as in the comparison screen (Figure 1B), where users may display hemodynamic measurement before and after TAVR.…”

Section: Study Devicementioning

confidence: 99%

Evaluation of the OpSens OptoWire III and Novel TAVR Algorithm to Measure Pressure Gradient During TAVR

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Kipperman

Disla

et al. 2022

Journal of the Society for Cardiovascular Angiography & Int

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“…Using the dicrotic notch index (DNI) to assess for PVL is currently under investigation. 22 The DNI does not require LV measurements, alleviating the need for a LV pigtail, which can further strip down the TAVRprocedure.…”

Section: Procedures Simplificationmentioning

confidence: 99%

Pathways Towards Lean TAVR

et al. 2020

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Association of a Novel Hemodynamic Index With Aortic Regurgitation After TAVR With the Edwards SAPIEN Valve

Cited by 7 publications

References 5 publications

Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR

Impact of Intraprocedural Pressure Changes on Hemodynamic Outcome During Self-Expanding TAVR

Evaluation of the OpSens OptoWire III and Novel TAVR Algorithm to Measure Pressure Gradient During TAVR

Pathways Towards Lean TAVR

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