Vascular Effects of TAVR | Journal Scan

Feb 03, 2015
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Authors:
Yotti R, Bermejo J, Gutiérrez-Ibañes E, et al.
Citation:
Systemic Vascular Load in Calcific Degenerative Aortic Valve Stenosis: Insight From Percutaneous Valve Replacement. J Am Coll Cardiol 2015;65:423-433.
Summary By:
Troy M LaBounty, MD, FACC

Study Questions:

What is the effect of aortic stenosis (AS) on vascular function?

Methods:

This study examined aortic pressure and flow in 23 patients before and after transcatheter aortic valve replacement (TAVR), with follow-up for blood pressure and clinical status at 6 months.

Results:

Significant hemodynamic changes between pre- and post-TAVR measurements included stroke volume index (41 ± 8 vs. 33 ± 10 ml/m2, p < 0.001), systolic blood pressure (130 ± 24 vs. 162 ± 23 mm Hg, p = 0.003), left ventricular end-systolic (186 ± 36 vs. 162 ± 23, p = 0.003) and end-diastolic pressure (23 ± 7 vs. 26 ± 7, p = 0.004), and mean gradient (49 ± 19 vs. 10 ± 3 mm Hg, p < 0.001). There was a significant increase in both forward and backward compression waves after TAVR, and indices of vascular function demonstrated increased stiffness after TAVR (p < 0.05 for all). Within 2 days of TAVR, 12/23 (52%) patients had a hypertensive response, and five additional patients required increased antihypertensive use at 6 months of follow-up.

Conclusions:

The authors concluded that treatment of aortic stenosis with TAVR results in increased arterial pressures and greater vascular stiffness.

Perspective:

The authors used measurements before and after TAVR as a means to examine the effect of valvular stenosis on vascular hemodynamics. This study observes that aortic stenosis limits the conversion of ejected blood momentum into forward compression waves, resulting in dampening of these waves as well as the reflected backwards compression waves. Relief of valvular obstruction acutely increases both forward and backward compression waves, which increases both arterial pressure and systemic arterial load. A majority of patients had a hypertensive response following TAVR, reflecting a negative vascular response after TAVR that may be due in part to the increased vascular load. These findings help explain why so many patients need up-titration of antihypertensive medications after TAVR, and improve our understanding of the physiology associated with valvular stenosis and its acute relief.

Keywords: Aortic Valve Stenosis, Transcatheter Aortic Valve Replacement, Hypertension, Antihypertensive Agents, Hemodynamics, Stroke Volume, Vascular Stiffness, Blood Pressure


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