Journal of cardiothoracic and vascular anesthesia · 2024
Impact of Pressure Recovery Adjustment on Aortic Valve Area Classification of Disease Severity in Transcatheter Aortic Valve Replacement Patients.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Gonzalez-Ciccarelli Luis F, Ferrufino Renan A, Alfadhel Abdulaziz, Brovman Ethan, Ortoleva Jamel, Wessler Benjamin S, Fettiplace Michael, Cobey Frederick
Аннотация
OBJECTIVES: To determine the impact of pressure recovery (PR) adjustment on disease severity grading in patients with severe aortic stenosis. The authors hypothesized that accounting for PR would result in echocardiographic reclassification of aortic stenosis severity in a significant number of patients.
DESIGN: A retrospective observational study between October 2013 and February 2021.
SETTING: A single-center, quaternary-care academic center.
PARTICIPANTS: Adults (≥18 years old) who underwent transcatheter aortic valve implantation (TAVI).
INTERVENTIONS: TAVI.
MEASUREMENTS AND MAIN RESULTS: A total of 342 patients were evaluated in this study. Left ventricle mass index was significantly greater in patients who continued to be severe after PR (100.47 ± 28.77 v 90.15 ± 24.03, p = < 0.000001). Using PR-adjusted aortic valve area (AVA) resulted in the reclassification of 81 patients (24%) from severe to moderate aortic stenosis (AVA >1.0 cm2). Of the 81 patients who were reclassified, 23 patients (28%) had sinotubular junction (STJ) diameters >3.0 cm.
CONCLUSION: Adjusting calculated AVA for PR resulted in a reclassification of a significant number of adult patients from severe to moderate aortic stenosis. PR was significantly larger in patients who reclassified from severe to moderate aortic stenosis after adjusting for PR. PR appeared to remain relevant in patients with STJ ≥3.0 cm. Clinicians need to be aware of PR and how to account for its effect when measuring pressure gradients with Doppler.
DESIGN: A retrospective observational study between October 2013 and February 2021.
SETTING: A single-center, quaternary-care academic center.
PARTICIPANTS: Adults (≥18 years old) who underwent transcatheter aortic valve implantation (TAVI).
INTERVENTIONS: TAVI.
MEASUREMENTS AND MAIN RESULTS: A total of 342 patients were evaluated in this study. Left ventricle mass index was significantly greater in patients who continued to be severe after PR (100.47 ± 28.77 v 90.15 ± 24.03, p = < 0.000001). Using PR-adjusted aortic valve area (AVA) resulted in the reclassification of 81 patients (24%) from severe to moderate aortic stenosis (AVA >1.0 cm2). Of the 81 patients who were reclassified, 23 patients (28%) had sinotubular junction (STJ) diameters >3.0 cm.
CONCLUSION: Adjusting calculated AVA for PR resulted in a reclassification of a significant number of adult patients from severe to moderate aortic stenosis. PR was significantly larger in patients who reclassified from severe to moderate aortic stenosis after adjusting for PR. PR appeared to remain relevant in patients with STJ ≥3.0 cm. Clinicians need to be aware of PR and how to account for its effect when measuring pressure gradients with Doppler.