Hemodynamic outcomes of transcatheter aortic valve implantation with the CoreValve system: an early assessment

Summary Background and Aims Transcatheter aortic valve implantation ( TAVI ) is an established method for the treatment of high‐risk patients with aortic stenosis ( AS ). The beneficial effects of TAVI in cardiac hemodynamics have been described in recent studies, but those investigations were mostly performed after an interval of more than 6 months following aortic valve implantation. The aim of this study is to investigate the acute and short‐term alterations in hemodynamic conditions using the echocardiography outcomes in patients undergoing TAVI . Methods and Results A total of 60 patients (26 males, 34 females; age 84·7 ± 5·8) who underwent TAVI with CoreValve system were included in the study. Echocardiography was performed before hospital discharge and at 3 months follow‐up. As expected, TAVI was associated with an immediate significant improvement in aortic valve area ( AVA ) (from 0·64 ± 0·16 cm 2 to 1·67 ± 0·41 cm 2 , P ‐value<0·001) and mean gradient (from 51·9 ± 15·4 mmHg to 8·8 ± 3·8 mmHg, P ‐value<0·001). At 3‐month follow‐up, systolic LV function was augmented ( EF : 50 ± 14% to 54 ± 11%, P ‐value = 0·024). Left ventricle (LV) mass and left atrium (LA) volume were significantly reduced ( LV mass index from 126·5 ± 30·5 g m −2 to 102·4 ± 32·4 g m −2 ; LA index from 42·9 ± 17·3 ml m −2 to 33·6 ± 10·6 ml m −2 ; P ‐value<0·001 for both). Furthermore, a decrement in systolic pulmonary artery pressure ( SPAP ) from 47·5 ± 13·5 mmHg to 42·5 ± 11·2 mmHg, P ‐value = 0·02 was also observed. Despite the high incidence of paravalvular regurgitation ( PVR ) (80%), most of the patients presented mild or trace PVR and no significant progress of the regurgitation grade was seen after 3 months. Conclusion This study demonstrates that the beneficial effects of TAVI in cardiac function and hemodynamics occur already after a short period following aortic valve implantation.