title: Intraoperative improvement in left ventricular peak systolic velocity predicts better short-term outcome after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Left ventricular function is expected to improve after transcatheter aortic valve implantation due to the acute reduction in afterload, but does not occur in all patients. We hypothesized that the immediate intraoperative response in systolic left ventricular longitudinal motion during the procedure could be a predictor of short-term outcome.
  
  
  METHODS
  Sixty-four patients treated with transcatheter aortic valve implantation for severe aortic stenosis were included. Transoesophageal 4- and 2-chamber echocardiograms were obtained immediately prior to and ∼15 min after valve implantation. Patients were defined as responders if their average left ventricular longitudinal peak systolic velocity increased by ≥20% from the preimplantation value and was related to the 3-month outcome.
  
  
  RESULTS
  Thirty-five patients were classified as responders, with an increase in the intraoperative longitudinal peak systolic velocity from an average of 2.2 ± 0.8 to 3.1 ± 1.1 cm/s (P < 0.001); the velocity was unchanged in the remaining 29 patients, who averaged 2.4 ± 1.1 cm/s. There were significantly fewer adverse cardiac events in the responder group at the 3-month follow-up (20 vs 45%, P = 0.03) and the New York Heart Association class was significantly better in the responders compared with non-responders. Responders had a significant reduction in N-terminal probrain natriuretic peptide levels [243 (113-361) vs 163 (64-273), P = 0.004] at the 3-month follow-up, whereas non-responders did not [469 (130-858) vs 289 (157-921), P = 0.48].
  
  
  CONCLUSIONS
  An immediate improvement in the longitudinal peak systolic velocity during the transcatheter aortic valve implantation procedure predicted a better short-term outcome and may be useful in identifying patients who are at risk of a less favourable outcome after transcatheter aortic valve implantation.
authors.affiliation: The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Jo
authors.initials: J
authors.lastname: Eidet
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: Gry
authors.initials: G
authors.lastname: Dahle
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Jan Frederik
authors.initials: JF
authors.lastname: Bugge
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Bendz
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: Kjell Arne
authors.initials: KA
authors.lastname: Rein
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Aaberge
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Jon Thomas
authors.initials: JT
authors.lastname: Offstad
authors.affiliation: The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.affiliation: The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway sthalvor@ous-hf.no.
authors.forename: Per Steinar
authors.initials: PS
authors.lastname: Halvorsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity / Q000502:physiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D013599:Systole; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Aortic stenosis; Left ventricular function; Tissue Doppler imaging; Transcatheter aortic valve implantation