Blood flow characteristics in the ascending aorta after TAVI compared to surgical aortic valve replacement.
Ascending aortic blood flow characteristics are altered after aortic valve surgery, but the effect of transcatheter aortic valve implantation (TAVI) is unknown. Abnormal flow may be associated with aortic and cardiac remodeling. We analyzed blood flow characteristics in the ascending aorta after TAVI in comparison to conventional stented aortic bioprostheses (AVR) and healthy subjects using time-resolved three-dimensional flow-sensitive cardiovascular magnetic resonance imaging (4D-flow MRI). Seventeen patients with TAVI (Edwards Sapien XT), 12 with AVR and 9 healthy controls underwent 4D-flow MRI of the ascending aorta. Target parameters were: severity of vortical and helical flow pattern (semiquantitative grading from 0 = none to 3 = severe) and the local distribution of systolic wall shear stress (WSSsystole). AVR revealed significantly more extensive vortical and helical flow pattern than TAVI (p = 0.042 and p = 0.002) and controls (p < 0.001 and p = 0.001). TAVI showed significantly more extensive vortical flow than controls (p < 0.001). Both TAVI and AVR revealed marked blood flow eccentricity (64.7 and 66.7%, respectively), whereas controls showed central blood flow (88.9%). TAVI and AVR exhibited an asymmetric distribution of WSSsystole in the mid-ascending aorta with local maxima at the right anterior aortic wall and local minima at the left posterior wall. In contrast, controls showed a symmetric distribution of WSSsystole along the aortic circumference. Blood flow was significantly altered in the ascending aorta after TAVI and AVR. Changes were similar regarding WSSsystole distribution, while TAVI resulted in less helical and vortical blood flow.
Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Charité Medical University Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.|Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany.
Ralf Felix
RF
Trauzeddel
Department of Cardiology, Immanuel Klinikum Bernau, Heart Center Brandenburg, Bernau, Germany.
Ulrike
U
Löbe
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.|Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA.
Alex J
AJ
Barker
Department of Cardiology, Immanuel Klinikum Bernau, Heart Center Brandenburg, Bernau, Germany.
Carmen
C
Gelsinger
Department of Cardiology, Immanuel Klinikum Bernau, Heart Center Brandenburg, Bernau, Germany.
Christian
C
Butter
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.|Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA.
Michael
M
Markl
Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Charité Medical University Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.|Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany.
Jeanette
J
Schulz-Menger
Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Charité Medical University Berlin, Lindenberger Weg 80, 13125, Berlin, Germany. florian.von-knobelsdorff@charite.de.|Department of Cardiology and Nephrology, HELIOS Klinikum Berlin Buch, Berlin, Germany. florian.von-knobelsdorff@charite.de.
Florian
F
von Knobelsdorff-Brenkenhoff
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000503:physiopathology*; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001705:Bioprosthesis; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization / Q000295:instrumentation; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D055420:Perfusion Imaging / Q000379:methods; D010865:Pilot Projects; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015607:Stents; D013314:Stress, Mechanical; D016896:Treatment Outcome
4D-flow; Aorta; Aortic valve replacement; Magnetic resonance imaging; Shear stress; Transcatheter aortic valve implantation