Improved Exercise Tolerance, Oxygen Delivery, and Oxygen Utilization After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Abstract

Background Transcatheter aortic valve implantation (TAVI) represents an effective therapeutic procedure, particularly in patients with severe aortic stenosis. We hypothesized that the decreased afterload induced by TAVI would improve exercise capacity by enhancing oxygen uptake in working muscles. Methods A standardized exercise test was performed in patients with severe aortic stenosis the day before TAVI and within 5 days thereafter. The main study endpoint was the workload achieved during a 5-minute standardized exercise test. Using electrical cardiometry and near-infrared spectroscopy, we explored and compared the changes in cardiac index (CI), as well as muscular and cerebral tissue oximetry, during the 2 exercise tests. Results Thirty patients completed the study protocol. Compared with the pre-TAVI period, patients achieved a higher median workload after TAVI (316 Joules [interquartile range {IQR}: 169–494] vs 190 Joules [IQR: 131–301], P = 0.002). Baseline CI increased from 2.5 l/min per m 2 (IQR: 2.1–2.9) to 2.9 l/min per m 2 (IQR: 2.5–3.2; P = 0.009), whereas CI at the end of the exercise test increased from 4.5 l/min per m 2 (IQR: 3.4–5.3) to 4.7 l/min per m 2 (3.4–6.4; P = 0.019). At the end of the exercise test, cerebral tissue oximetry increased from 70% (IQR: 65–72) to 74% (IQR: 66–78), and muscle tissue oximetry increased from 62% (IQR: 58–65) to 71% (65–74; P = 0.046 and P < 0.001, respectively). Conclusions Early improvement of exercise capacity after TAVI is associated with increased CI and better oxygen utilization in the brain and skeletal muscles.

Myocardial proteome changes in aortic stenosis rats subjected to long‐term aerobic exercise

“…Exercise prevents damage to the heart caused by various types of injury (Pazzianotto‐Forti et al, 2020; Saco‐Ledo et al, 2020; Sjölin et al, 2020; Suppan et al, 2020). As rats with persistent pressure overload are intolerant to physical effort, we used a moderate‐volume, low‐intensity training protocol (de Souza et al, 2020; Mota et al, 2020).…”

Cerebral Tissue Oxygen Saturation Is Enhanced in Patients following Transcatheter Aortic Valve Implantation: A Retrospective Study

“…It should be noted, however, that the magnitude of the rise in rSO 2 observed in this study was much lower than in those patients. Furthermore, although values of baseline rSO 2 were comparable, Suppan et al observed improved rSO 2 and cardiac output following cardiopulmonary exercise testing 5 days after TAVI [ 29 ]. Consequently, the rise in rSO 2 observed in this study might not be a short-term change.…”