Incidence, outcome and correlates of residual paravalvular aortic regurgitation after transcatheter aortic valve implantation and importance of haemodynamic assessment

Abstract

In patients undergoing TAVI, moderate and moderate-to-severe PAR was observed in 14.4% and associated with increased cardiovascular mortality. A pressure gradient ∆PDAP-LVEDP≤18 mmHg carries adverse prognosis and requires further intervention.

Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality

“…⌬P DAP-LVEDP (14), the AR index as the ratio of the gradient between DAP and LVEDP to SBP (20), and the DPTI:SPTI ratio were calculated. The DPTI was calculated from the planimetric integration of the area between the aortic and LV pressure tracings during diastole.…”

“…We have therefore now calculated the DPTI:SPTI ratio following the TAVI procedure and related it to cardiovascular mortality. Hemodynamics and outcome of these patients have been reported before (14).…”

“…In conclusion, DPTI:SPTI provides an excellent cutoff value of Յ0.7 for the prediction of PAR-associated mortality. aortic regurgitation; aortic stenosis; transcatheter aortic valve implantation.THE INCIDENCE OF moderate and severe paravalvular aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) varies from 10 to 20% (4,5,17,(21)(22)(23)27), and moderate-to-severe PAR after TAVI is associated with increased in-hospital mortality and unfavorable long-term outcome (1,11,14,20). PAR severity during TAVI is usually graded qualitatively using angiography.…”

“…PAR severity during TAVI is usually graded qualitatively using angiography. Quantitative evaluation of PAR has been recently proposed by use of the aortic regurgitation (AR) index, which is calculated as the ratio of the gradient between diastolic aortic pressure (DAP) and left ventricular (LV) end-diastolic pressure (LVEDP) to systolic blood pressure (SBP) ϫ 100 or [(DAP-LVEDP)/SBP] ϫ 100 (20) or more simply by use of the pressure difference between DAP and LVEDP (⌬P DAP-LVEDP ) (14). A pathophysiological understanding of PAR and its consequences is a prerequisite for an effective treatment and the improvement of survival.…”

Aortic Regurgitation After Transcatheter Aortic Valve Replacement

“…22 Furthermore, the ratio of the diastolic over the systolic pressure time integral (DPTI:SPTI) has been proposed as an estimate of myocardial oxygen supply vs. demand and the propensity for myocardial ischemia. Patsalis et al 23, 24 elegantly estimated the myocardial supply-demand ratio from the planimetric integration of the diastolic and systolic pressure-time area (DPTI and SPTI), respectively. Interestingly, DPTI:SPTI decreased with increasing Sellers grade of paravalvular AR.…”