Successful transcatheter aortic valve implantation (TAVI) is associated with transient left ventricular dysfunction

Abstract

Objective To investigate early haemodynamic changes after transfemoral transcatheter aortic valve implantation (TAVI) and the relationship with myocardial injury and neurohormonal activation. Design Single-centre prospective observational study. Setting Tertiary cardiac centre. Patients 42 patients undergoing transfemoral TAVI were included in this study. Main outcome measures Haemodynamic measurements and echocardiography-derived indices characterising myocardial function were recorded at baseline, 6 and 24 h postprocedure. Postprocedural myocardial injury was quantified using serum troponin I and CK-MB levels. In addition, biomarkers of myocardial dysfunction/heart failure and neurohormonal activation were measured. Results 6 h Post-TAVI there was a significant deterioration in both systolic and diastolic function as measured by dP/dt max /EDV, myocardial performance index and mean E/e' index. Recovery of myocardial function was observed at 24 h. These haemodynamic changes were associated with a significant increase in both troponin I (0.0760.01 vs 1.5960.21 mg/l, p<0.005) and CK-MB (1.9960.19 vs 6.8260.7 ng/ml, p<0.005). There was a positive correlation among myocardial injury and NT-BNP (r¼0.34, p<0.0005), aldosterone (r¼0.56, p<0.0001) and ST2 levels (r¼0.21, p<0.05). Conclusions This is the first study to demonstrate that procedurally successful TF-TAVI results in a transient depression of both systolic and diastolic left ventricular function within the first 24 postoperative hours, despite impressive relief of previously severe, chronic pressure overload. The rise in the markers of myocardial damage suggests that this may be due to periprocedural myocardial injury. Complete recovery of contractility is generally observed after 24 h.

Progressive rise in red cell distribution width is associated with poor outcome after transcatheter aortic valve implantation

“…Our group have previously shown that even successful TAVI is linked with transient left ventricular dysfunction 39. RDW is an independent predictor of mortality in patients with acute heart failure,40 but further studies are needed to clarify whether RDW correlates with the extent of such procedural haemodynamic changes in the setting of TAVI.…”

Optimal pain management after aortic valve implantation: an opportunity to improve outcomes after transapical access in the future?

“…Published and unpublished data from our own group also show that this inflammatory response is significantly higher in patients undergoing transapical procedures 11. In this context it is interesting to know that TEA inhibits intraoperative cortisol as well as catecholamine surge and reduces inflammatory response after cardiopulmonary bypass surgery 12.…”

Almanac 2013: Novel non-coronary cardiac interventions

“…A recent study has shown that there is transient systolic and diastolic dysfunction within the first 24 h of a successful TAVR 51. This is associated with an increase in serum markers of myocardial injury and dysfunction suggesting that the post-procedural dysfunction is due to myocardial stunning and periprocedural injury to the myocardium.…”