[Monitoring of haemodynamics and function of the aortic prosthesis during transcatheter aortic valve replacement].

PURPOSE: To find an advisability of use of invasive monitoring of intracardiac haemodynamics during transfemoral transcatheter aortic valve replacement.

PATIENTS AND

METHODS

The study included 12 patients underwent transfemoral transcatheter aortic valve replacement (TTAVR). All patients were monitored according to Harvard standard. Additionally, we performed a catheterization of the right heart chambers, transesophageal or transthoracic echocardiography. Pressure in the left ventricle and aorta was measured directly after implantation ofthe aortic prosthesis.

RESULTS

Cardiac output was increased authentically in comparison with baseline in all patients. There was cardiac index increasing, however the increasing was not reliable (p ≤ 0.07). In 9 cases, baseline pulmonary artery pressure (PAP) was not changed during surgery. In 3 patients, PAP and pulmonary artery wedge pressure (PAOP) before surgery were increased. In 2 of this 3 patients, PAP and PAOP were significantly decreased after surgery. In 1 case, the pressure in the pulmonary circulation stayed increased. Ejection fraction (EF) of the left ventricle was increased after surgeries in 2 patients from 30 to 40% and from 20 to 25%. The values of stroke volume and stroke index were similar in all patients before and after surgeries. Valvular regurgitation after successful implantation of the aortic prosthesis was found in 11 patients (91.6%). We calculated dia- stolic gradient of left ventricle and the aorta and aortic regurgitation index and compared this parameters with data of echocardiography. The index of aortic regurgitation was 36.5 (35; 46), and diastolic pressure gradient in the aorta and ventricle was 48.0 (40.5; 65.5) mmHg. Calculated systolic pressure gradient in the left ventricle and aorta was 5.5 (3.0; 11.5) mmHg., this data proved that there was no stenosis of aortic prosthesis.

CONCLUSION

Invasive monitoring of intracardiac haemodynamics during transfemoral transcatheter aortic valve replace-ment allows to diagnose quality of prosthesis implantation accurately and provides data about valvular regurgitation. Invasive monitoring helps to provide haemodynamic stability in patients with critical aortic stenosis during anaesthesia.