title: Long-term outcomes after transcatheter aortic valve implantation: the impact of intraoperative tissue Doppler echocardiography.
abstract: Transcatheter aortic valve implantation improves survival in patients with severe aortic stenosis who are ineligible for surgical valve replacement; however, not all patients benefit from the procedure. We endeavoured to identify these patients using intraoperative echocardiography and hypothesized that intraoperative left ventricular function in response to the acute afterload reduction during the procedure was related to long-term outcomes.
  
  
  
  We prospectively included 64 patients who were scheduled for transcatheter aortic valve implantation and divided them into responders and non-responders based on their left ventricular intraoperative responses to the acute afterload reduction after valve deployment. Responders were defined by increases of ≥20% in left ventricular longitudinal peak systolic velocities determined by tissue Doppler echocardiography. All patients were assessed for the following outcomes at 12 months: cardiac mortality, adverse cardiac events, quality of life, New York Heart Association class, N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiography.
  
  
  
  Thirty-five patients (55%) were classified as responders and 29 patients (45%) as non-responders. Compared with responders, non-responders had higher risks of death (28 vs 9%, respectively, P = 0.04) and cardiac events (66 vs 26%, respectively, P < 0.01) during the 12-month follow-up. Significant long-term improvements in quality of life, NT-proBNP and left ventricular function were observed only in the responders. Preoperative risk stratification, intraoperative handling, aortic gradient and valve area were similar between groups.
  
  
  
  Intraoperative assessment of left ventricular function by tissue Doppler echocardiography predicted long-term outcomes after transcatheter aortic valve implantation. Our results suggest that a preoperative test of myocardial contractile reserve might improve risk stratification and patient selection prior to the procedure.
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 F
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 A
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 T
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 Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, 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 S
authors.initials: PS
authors.lastname: Halvorsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011788:Quality of Life; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Aortic stenosis; Colour tissue Doppler imaging; Long-term outcomes; Transcatheter aortic valve implantation